Development of a Subtle Screening for Suicidal Ideation: Psychometric Characteristics and Implications for Family Therapists

Abstract

While 10 million U.S. adults experience suicidal thoughts and 1.7 million attempt suicide annually, candid, truthful endorsement of assessment items related to suicidal ideation (SI) can be inhibited by stigma, shame, and embarrassment and a fear of involuntary hospitalization. Suicidal ideation in, and suicide attempts by, family members increase the suicide risk among other members by several times, and so accurate detection of SI is crucial for couple and family therapists. To address concerns about stigma and false negatives in screening for SI, a 19-item subtle screening of suicidal ideation (SSSI) was developed from a pool of 32 “proxy” items tapping psychological pain, emotional intelligence, and negative alterations in mood and cognitions. A demographics form, a measure of suicidal ideation, measures of anxiety, depression, and traumatic stress, and versions of the Beck Hopelessness Scale and the Interpersonal Needs Questionnaire were also used for data collection. Principal components analysis and reliability, correlation, and multiple regression procedures on data from a non-random, diverse sample of adults (N = 306) provided evidence of excellent reliability (α = .93) and convergent and discriminant validity for the SSSI. The three-dimensional SSSI accounted for 54.9% of the variance in a direct measure of suicidal thoughts, and a Receiver Operator Characteristic curve identified a cut-off score of 35 with a sensitivity of .937 and specificity of .81, indicating the instrument successfully identifies those with and without suicidal thoughts. Clinical implications and future research are discussed.