scales to fill out before and after coming to see dr persaud
Intensity of Suicidal Ideation
Scale for Suicidal Ideation
The Scale for Suicide Ideation (SSI) is a 21-item, interviewer-administered scale that measures the current intensity of patients’ specific attitudes, behaviors, and plans to commit suicide on the day of the interview and during the time period that they were most suicidal. The first 5 items are screeners (wish to live, wish to die, and desire to attempt suicide), followed by 14 items to assess suicidal risk factors. The last 2 items capture previous suicide attempts. The respondent is first asked all questions about their suicidal ideation on the day of the interview and then queried about the most severe point of suicidal ideation.
Each item is rated on a 3-point scale ranging from 0 to 2 according to suicidal intensity. The SSI is scored by adding up the ratings (0-2) from the first 19 items.
Specific Instructions
This protocol includes questions that can potentially identify respondents who are at risk of suicide. Investigators implementing this protocol should consider developing a risk management plan specific to their study to ensure the safety of participants. The following links provide additional information and guidelines for suicide-related research:
ora.research.ucla.edu/OHRPP/Documents/Policy/8/Risk_of_Suicide.pdf
Protocol
Day of Interview
Time of Crisis/Most Severe Point of Illness
Today’s Date:
___ / ___ / ___
Approximate Date at Most Severe Point:
___ / ___ / ___
I. Characteristics of Attitude Toward Living/Dying
( )
1. Wish to Live
0 Moderate to strong
1 Weak
2 None
( )
( )
2. Wish to Die
0 None
1 Weak
2 Moderate to strong
( )
( )
3. Reasons for Living/Dying
0 For living outweigh for dying
1 About equal
2 For dying outweigh for living
( )
( )
4. Desire to Make Active Suicide Attempt
0 None
1 Weak
2 Moderate to strong
( )
( )
5. Passive Suicidal Attempt
0 Would take precautions to save life
1 Would leave life/death to chance
(e.g., carelessly crossing a busy street)
2 Would avoid steps necessary to save or maintain life
(e.g., diabetic ceasing to take insulin)
( )
If all four code entries for Items 4 and 5 are "0,"
skip Sections II, III, and IV.
II. Characteristics of Suicide Ideation/Wish
( )
6. Time Dimension: Duration
0 Brief, fleeting periods
1 Longer periods
2 Continuous (chronic), or almost continuous
( )
( )
7. Time Dimension: Frequency
0 Rare, occasional
1 Intermittent
2 Persistent or continuous
( )
( )
8. Attitude Toward Ideation/Wish
0 Rejecting
1 Ambivalent; indifferent
2 Accepting
( )
( )
9. Control Over Suicidal Action/Acting Out Wish
0 Has sense of control
1 Unsure of control
2 Has no sense of control
( )
( )
10. Deterrents to Active Attempt
(e.g., family, religion; possibility of serious injury if unsuccessful;
irreversibility)
0 Would not attempt suicide because of a deterrent
1 Some concern about deterrents
2 Minimal or no concern about deterrents
Indicate deterrents, if any:_________________
( )
( )
11. Reason for Contemplated Attempt
0 To manipulate the environment; get attention revenge
1 Combination of "0" and "2"
2 Escape, surcease, solve problems
( )
III. Characteristics of Contemplated Attempt
( )
12. Method: Specificity/Planning
0 Not considered
1 Considered, but details not worked out
2 Details worked out/well formulated
( )
( )
13.Method: Availability/Opportunity
0 Method not available; no opportunity
1 Method would take time/effort; opportunity not readily available
2a Method and opportunity available
2b Future opportunity or availability of method anticipated
( )
( )
14. Sense of "Capability" to Carry Out Attempt
0 No courage, too weak, afraid, incompetent
1 Unsure of courage, competence
2 Sure of competence, courage
( )
( )
15. Expectancy/Anticipation of Actual Attempt
0 No
1 Uncertain, not sure
2 Yes
IV. Actualization of Contemplated Attempt
( )
16.Actual Preparation
0 None
1 Partial (e.g., starting to collect pills)
2 Complete (e.g., had pills, razor, loaded gun)
( )
( )
17.Suicide Note
0 None
1 Started but not completed; only thought about
2 Completed
( )
( )
18. Final Acts in Anticipation of Death (e.g., insurance, will, gifts)
0 None
1 Thought about or made some arrangements
2 Made definite plans or completed arrangements
( )
( )
19. Deception/Concealment of Contemplated Attempt
(Refers to communication of ideation to interviewing clinician)
0 Revealed ideas openly
1 Held back on revealing
2 Attempted to deceive, conceal, lie
( )
V. Background Factors
( )
20. Previous Suicide Attempts
0 None
1 One
2 More than one
( )
( )
21. Intent to Die Associated with Last Attempt (if N/A enter "8")
0 Low
1 Moderate; ambivalent, unsure
2 High
( )
Scoring
Each item is rated on a 3-point scale ranging from 0 to 2 according to suicidal intensity. The SSI is scored by adding up the ratings (0-2) from the first 19 items.