diagnostic tool has demonstrated clinical value for assessing short-term suicide risk among high-risk individuals (Calati, Cohen, Schuck, Levy, et al., 2020; Hawes, Yaseen, Briggs, & Galynker, 2017). In these two studies, the authors conducted research to assess the predictive validity for suicidal behavior (SB) using the MARIS in psychiatric patients following discharge from an inpatient unit. The MARIS and a psychological test battery were administered to 136 adult psychiatric patients hospitalized for high risk of suicide. Eighty-six participants had complete data at discharge and 59 (69.8%) were reached for follow-up. Logistic regressions were used to assess the predictive validity of the MARIS for SB over the four to eight weeks following hospital discharge and its incremental predictive validity over standard risk factors. Patients who exhibited SB in the period between initial assessment and follow-up had significantly higher MARIS scores. ROC analysis indicated good sensitivity and specificity of MARIS in identifying risk (OR=19). Further, MARIS total score significantly improved predictive validity by the standard risk factors when added to a model comprising global depression severity, hopelessness, and lifetime number of suicide attempts, and was the only factor that approached independent significance. The MARIS appears to be a practical and effective tool for detecting short-term suicide risk following hospital discharge, supporting the validity of modular multi-informant approach to suicide risk evaluation. Replication of these findings and further investigation of the applications of such an approach are warranted. In another approach known as the Collaborative Assessment and Management of Suicidality (CAMS), Jobes (2016) uses the Suicide Status Form (SSF) to assess initial risk, track risk throughout the course of treatment, and assess clinical outcomes. In the CAMS approach, eliciting the patient’s perspective is considered the goal of assessment. Thus, the SSF is completed collaboratively between clinician and patient on a regular basis. In fact, it is recommended that the clinician and patient sit side by side, in order to better assist the clinician in viewing the experience through the patient’s eyes. The SSF consists of sections focused on: ● Patient ratings of psychological pain, stress, agitation, hopelessness, self-hate, and overall suicide risk (patient report). ● Reasons for living and reasons for dying (patient report). ● Current empirically-supported suicide risk factors (clinician interview). ● Outpatient treatment plan (clinician directed). ● Post-session evaluation of mental status, diagnoses, overall risk assessment, and case notes (clinician reported). The CAMS approach continues to develop a sound empirical evidence base and will serve as a useful tool for suicide risk assessment in any clinical setting (Huh, Jobes, Comtois, Kerbrat, Chalker, et al.,2018). Jobes (2016) further details the CAMS approach. The Columbia-Suicide Severity Rating Scale (C-SSRS) is a questionnaire used for suicide assessment. It is available in 114 country-specific languages. Mental health training is not required to administer the C-SSRS. Three versions of the C-SSRS are available for use in clinical practice (Gerstenhaber, 2016). The Lifetime/Recent version is used to gather lifetime history of suicidality as well as any recent suicidal ideation and/or behavior. The Since Last Visit version assesses suicidality since the patient’s last visit. The Screener version of the C-SSRS is a truncated form of the full version. Various professionals can administer this Virtual suicide risk assessment measures With regard to suicide-specific online measures, the field of virtual suicide assessment has boomed over the last few years. New improvements have been made with real-time monitoring of suicide risk (Kleiman, Turner, Fedor, Beale, Huffman, & Nock, 2017) and integrating virtual suicide monitoring into general hospital settings and emergency departments (Kroll, Stanghellini,
scale, including physicians, nurses, psychologists, social workers, peer counselors, coordinators, research assistants, high school students, teachers, and clergy. The C-SSRS supports suicide risk assessment through a series of simple, plain-language questions. The answers help users identify whether someone is at risk for suicide, assess the severity and immediacy of that risk, and gauge the level of support the person needs. Users of the C- SSRS tool ask people: ● Whether and when they have thought about suicide (ideation). ● Which actions they have taken to prepare for suicide, and when. ● Whether and when they attempted suicide or began a suicide attempt that was either interrupted by another person or stopped of their own volition. Whichever clinical assessment measure is utilized, it is important to make sure the requirements of the measure fit the needs of the setting with regard to length of administration, required background of the clinical assessor, and the intervention/ documentation requirements of the setting/agency. Furthermore, any clinical assessment can be further informed by the suicide risk assessment modalities that will be discussed further along in this section. For clinicians wanting to obtain a thorough assessment of both NSSI and suicidal behavior, it is recommended that the Self- Injurious Thoughts and Behaviors Interview (SITBI; Nock et al., 2007; Fox et al., 2020) be used. The SITBI is a well-validated, structured clinical interview consisting of five modules that assess self-injury, suicidal ideation and plans, and suicidal behavior. A major focus of the interview is about the form, frequency, and severity of self-injury, as well as the frequency and intensity of urges about self-injury. Participants respond to open-ended questions about the frequency, methods, and severity of self- injury, and then they rate the various functions of self-injury as it applies to their behavior using a Likert scale ranging from 0 (never) to 4 (frequently). Options for the functions of self- injury include escaping aversive feelings, generating feelings, communication with others, or to avoid activities or others. Participants also rate the extent to which they feel pain during self-injury, and to what extent their family, friends, or peers may have contributed to self-injurious behavior. Finally, participants also rate the likelihood that they will engage in self-injury in the future. The SITBI interview also assesses the dangerousness of self- injurious behaviors and if previous medical attention was required for the behavior. The SITBI also consists of segments about the frequency, intensity, and duration of suicidal ideation in the past week through the past year, occurrence of suicidal plans and gestures, and detailed information about previous suicide attempts. Each of the five modules begins with an initial screening question, and if that initial question is endorsed, then the full module is included in the interview. This allows for skipping sections that are not relevant to an interviewee, thus reducing the total length of the interview. A particular advantage of the SITBI is that it includes a thorough assessment of suicidal ideation and behavior in addition to self-injury, a feature that is particularly useful given the high association between self- injury and suicidal behavior (Fox et al., 2020). The SITBI interview is freely available from the developer’s website (see the Resources section of this course) and comes in longer and shorter versions depending on assessment needs. With some time, preparation, and training, the interview can be integrated into a wide variety of clinical settings. DesRoches, et al., 2020). Numerous suicide risk assessment and safety planning apps have been studied, including: Virtual Hope Box (Bush, Smolenski, Denneson, et al., 2017), Stay Alive (Bakker, Kazantis, Rickwood, & Rickard, 2016), Suicide Safety Plan (de la Torre, Castillo, Arambarri, et al., 2017), and many others (Castillo- Sanchez, Camargo-Henriquez, Munoz-Sanchez, et al.,
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