Clinical utility of the brief suicide cognitions scale with high-risk inpatient, outpatient, and emergency department clinical samples

Abstract

The current study explored the clinical utility of the Brief Suicide Cognitions Scale (B-SCS) in multiple samples, including a normative sample and three clinical samples with varying degrees of suicide risk. Derived cutting scores were identical across an inpatient randomized clinical trial (RCT) sample, an emergency department (ED) sample, and an inpatient consecutive admission sample, with B-SCS scores at intake correctly predicting 96 % and 94 % of suicide attempts over six-month follow-up periods in the RCT and ED samples, respectively. Additionally, the B-SCS intake scores in the RCT sample predicted differences in high and low suicide ideation groups over the six-month follow-up period, with those below the B-SCS intake cutoff score reporting suicidal ideation scores within normal limits throughout the entirety of post-discharge follow-up. Current results support the recommendation that evaluation of the clinical utility of instruments identifying suicide risk require variable criteria depending on the specific clinical context and related clinical decision-making. With respect to post-discharge monitoring and related treatment tailoring for inpatient and ED clinical environments, instruments with strong sensitivity and high negative predictive value (NPV) estimates are of particular importance given the need to accurately recognize both the resolution of an acute episode of suicide risk and identify those vulnerable for future episodes. In the current study, the B-SCS had sensitivity estimates of .96 and .94 and NPV estimates of .97 and .93. in these clinical settings. Implications for day-to-day practice, the need for future research, and study limitations are discussed.