Introduction
Suicide is a fundamental public health concern, present in various settings worldwide. From these considerations, it is essential to develop a set of functional instruments to determine the severity of depression and suicidal behavior in patients. There are different approaches to analyzing suicidal thoughts, ranging from outside observations to direct communication with an individual at risk. The current paper thoroughly examines the Columbia Suicide Severity Rating Scale (C-SSRS), the 9-Question Patient Health Questionnaire (PHQ-9), and the Ask Suicide-Screening Questions (ASQ) toolkit. Ultimately, understanding the essence of each instrument is essential in ascertaining the risk factors that might lead to suicide.
Columbia Suicide Severity Rating Scale
Monitoring and preventing suicidal behaviors are some of the highest priorities in healthcare, and the C-SSRS is proved to be a practical framework for determining the patient’s mental health. A collaboration of several American universities developed the C-SSRS in an attempt to create a universal system of suicidal behavior assessment (Interian et al., 2017). The lack of a single framework to classify depression thoughts that might potentially lead to suicide has been a relevant problem in healthcare for an extensive period, and the C-SSRS was necessary to close the gap (Interian et al., 2017). Many research studies proved the effectiveness of the C-SSRS in accurately identifying the degree of suicidal thoughts (Interian et al., 2017). A detailed depiction of the behavior rating scale is presented below.
Several versions of the scale have the same objective of identifying suicidal behaviors but differ in terms of testing time and level of detail. The most accepted sample suitable for most interviews is the “C-SSRS Lifetime Recent – Clinical,” which was developed in 2008 and consisted of a set of questions regarding suicidal thoughts (Posner et al., 2008). The first part of the questionnaire includes five entries about the patient’s mental health during the past month and the development of suicidal thoughts over their lifetime (Posner et al., 2008). The examples of the questions are, “Have you wished you were dead or wished you could go to sleep and not wake up?” and “Have you actually had any thoughts of killing yourself?” (Posner et al., 2008, p. 2). For each entry, the patient must answer Yes or No, determining the consequent question.
Consequently, suppose the patient reports suicidal thoughts and answers Yes to questions 1 or 2. In that case, they have to complete the second part of the questionnaire, “Intensity of Ideation,” where they must thoroughly evaluate their thoughts over the past month and lifetime (Posner et al., 2008, p. 2). Lastly, the patients need to address their former suicidal behaviors. The scale classification includes non-suicidal self-injuries and actual, interrupted, and aborted suicide attempts to assess the patient’s mental health (Interian et al., 2017). Ultimately, if the patient answers Yes to any of the questions, they need to use the scale as a guideline and seek professional help.
9-Question Patient Health Questionnaire
The PHQ-9 is another major suicide ideation scale that evaluates the patient’s mental health. Compared to the C-SSRS, it is a much simpler version that could be used by the patients for self-report (Spitzer et al., n.d.). Furthermore, Na et al. (2018) compare the method to the C-SSRS and report limited accuracy of the PHQ-9 in suicide ideation. However, they also mention that the PHQ-9 is relatively precise, and the differences between the two methods are implied by the various degree of detail (Na et al., 2018). Thus, the primary advantage of PHQ-9 is its simplicity while also maintaining a high level of suicide ideation accuracy.
The PHQ-9 consists of nine questions with four answers for each inquiry. The examples of the entries are, “Over the last 2 weeks, how often have you been bothered by any of the following problems: little interest in doing things, poor appetite, etc.” (Spitzer et al., n.d.). Eight of the questions are indirect inquiries concerning the patient’s mental health and associated risk factors, while the ninth entry is a direct question concerning suicidal thoughts (Spitzer et al., n.d.). For each of the inquiries, the patient should choose a number on a scale from 0 to 3, where 0 is “not at all” and 3 is “nearly every day” (Spitzer et al., n.d.). Thus, the score ranges from 0 to 27 points, where the number from 20 to 27 implies severe depression, indicating the necessity of professional help (Na et al., 2018). Ultimately, compared to the C-SSRS, the PHQ-9 is less accurate but well-suited for a brief examination and self-reports.
Ask Suicide-Screening Questions
Lastly, the current paper examines the Ask Suicide-Screening Questions (ASQ) toolkit. Like the PHQ-9, the ASQ is a brief questionnaire suited for self-reports but is associated with a less accurate assessment of suicide ideation compared to the C-SSRS (National Institute of Mental Health, 2020). The research proved the reliability and validity of the ASQ method with a relatively high level of precision (Horowitz et al., 2020). Horowitz et al. (2020) compared the ASQ to other prominent suicide ideation screening tests with 4-item models and stated that the ASQ was a practical framework that could be applied universally. The authors demonstrated that each of the four questions in the method was a relevant metric to determine the level of suicidal thoughts in the patient, thus, proving the effectiveness of the ASQ (Horowitz et al., 2020). Ultimately, the ASQ is a brief but accurate framework for suicide ideation measurement.
The test presents four obligatory close-ended questions with additional inquiries if the patient answers Yes. The entries concern suicidal thoughts with such questions as, “In the past few weeks, have you felt that you or your family would be better off if you were dead?” (National Institute of Mental Health, 2020). Thus, unlike the PHQ-9, which is primarily concentrated on associated risk factors, the ASQ raises direct questions about suicidal behavior. Ultimately, if the patient answers Yes to any of the questions, they must seek professional help for a complete mental health evaluation and counseling.
Conclusion
All studied instruments convey the idea that suicide ideation always has external expression. For instance, Kliem et al. (2017, p. 1) accentuate “low socio-economic status, experienced child abuse, and mental disorders” as risk factors. According to Jordan et al. (2019), painful and provocative events and impulsivity are significant factors that help predict suicidal behavior. Furthermore, a surprising notion was presented by Harris and Goh (2017), who stated that conducting measurements of suicidal ideations was a risk factor in itself since answering questions may provoke suicidal reactions. Ultimately, there is no definitive way to predict with certainty that an individual will or will not commit suicide; however, the examined frameworks proved to be effective in accurately assessing suicide ideation.
References
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Posner, K., Brent, D., Lucas, C., Gould, M., Stanley, B., Brown, G.,… & Mann, J. (2008). Columbia-suicide severity rating scale (C-SSRS). Columbia University Medical Center, 10.
Spitzer, R., Williams, J. B. W., & Kroehnke, K. (n.d.). Patient Health Questionnaire-9. National Institute on Drug Abuse. Web.