Assessing a person's intent to die in a suicide attempt is crucial for risk assessment and research, yet suicidal intent is notoriously difficult to measure. People who intended to die when they hurt themselves may deny it, and others may feign intent for secondary gain. Additionally, ambivalence, memory gaps, impulsivity, and fluidity of intent can hinder accurate assessment of intent. Circumstantial evidence, such as a suicide note, may illuminate true intentions but also has substantial limitations. This article summarizes disparate challenges to the measurement of suicidal intent; describes strengths and weaknesses of circumstantial indicators; reviews evidence from studies using the Suicide Intent Scale to show that subjective and circumstantial indicators do not strongly correlate with each other; and concludes with a call to place more trust in individuals whose disclosures of suicidal intent are questionable, even if the possibility for manipulation exists.
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References
1.
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders: DSM-IV-TR (4th ed., text revision). Washington, DC: Author.
2.
AndriessenK. (2006). On “intention” in the definition of suicide. Suicide and Life-Threatening Behavior, 36, 533–538.
3.
BarberM. E.MarzukP.LeonA., & PorteraL. (1998). Aborted suicide attempts: A new classification of suicidal behavior. American Journal of Psychiatry, 155, 385–389.
4.
BeckA. T.BeckR., & KovacsM. (1975). Classification of suicidal behaviors: I. Quantifying intent and medical lethality. American Journal of Psychiatry, 132, 285–287.
5.
BeckA. T.SchuylerD., & HermanI. (1974). Development of suicidal intent scales. In BeckA. T.ResnikH. L. P., & LettieriD. J. (Eds.), The prediction of suicide (pp. 45–58). Bowie, MD: Charles Press.
6.
BeckA. T., & SteerR. A. (1989). Clinical predictors of eventual suicide: A 5- to 10-year prospective study of suicide attempters. Journal of Affective Disorders, 17, 203–209.
7.
BrentD. A.PerperJ. A.GoldsteinC. E.KolkoD. J.AllanM. J.AllmanC. J., & ZelenakJ. P. (1988). Risk factors for adolescent suicide: A comparison of adolescent suicide victims with suicidal inpatients. Archives of General Psychiatry, 45, 581–588.
8.
BrownG. K. (2002). A review of suicide assessment measures for intervention research with adults and older adults. Retrieved March 10, 2006, from the National Institute of Mental Health web site: http://www.nimh.nih.gov/suicideresearch/adultsuicide.pdf.
9.
BrownG. K.HenriquesG. R.SosdjanD., & BeckA. T. (2004). Suicide intent and accurate expectations of lethality: Predictors of medical lethality of suicide attempts. Journal of Consulting and Clinical Psychology, 72, 1170–1174.
10.
CaseyP. R. (1989). Personality disorder and suicide intent. Acta Psychiatrica Scandinavica, 79, 290–295.
11.
ChilesJ. A., & StrosahlK. (1995). The suicidal patient: Principles of assessment, treatment, and case management. Washington, DC: American Psychiatric Press, Inc.
12.
ConnL. M.RudnickB. F., & LionJ. R. (1984). Psychiatric care for patients with self-inflicted gunshot wounds. American Journal of Psychiatry, 141, 261–263.
13.
ConnerK. R.PhillipsM. R.MeldrumS.KnoxK. L.ZhangY. P., & YangG. H. (2005). Low-planned suicides in China. Psychological Medicine, 8, 1197–1204.
14.
de MooreG. M.PlewJ. D.BrayK. M., & SnarsJ. N. (1994). Survivors of self inflicted firearm injury: A liaison psychiatry perspective. The Medical Journal of Australia, 160, 421–425.
15.
DiazF. J.Baca-GarciaE.Diaz-SastreC.ResaE. G.BlascoH.BraquehaisC.Saiz-RuizJ., & de LeonJ. (2003). Dimensions of suicidal behavior according to patient reports. European Archives of Psychiatry and Clinical Neuroscience, 253, 197–202.
16.
DyerJ. A. T., & KreitmanN. (1984). Hopelessness, depression and suicidal intent in parasuicide. British Journal of Psychiatry, 144, 127–133.
17.
GoldneyR. D. (1981). Attempted suicide in young women: Correlates of lethality. British Journal of Psychiatry, 139, 382–390.
18.
GroholtB.EkebergO., & HaldorsenT. (2000). Adolescents hospitalised with deliberate self-harm: The significance of an intention to die. European Child & Adolescent Psychiatry, 9, 244–254.
19.
GutheilT. G., & SchetkyD. (1998). A date with death: Management of time-based and contingent suicidal intent. American Journal of Psychiatry, 11, 1502–1507.
20.
HamdiE.AminY., & MattarT. (1991). Clinical correlates of intent in attempted suicide. Acta Psychiatrica Scandinavica, 83, 406–411.
21.
HarrissL., & HawtonK. (2005). Suicidal intent in deliberate self-harm and the risk of suicide: The predictive power of the Suicide Intent Scale. Journal of Affective Disorders, 86, 225–233.
22.
HarrissL.HawtonK., & ZahlD. (2005). Value of measuring suicidal intent in the assessment of people attending hospital following self-poisoning or self-injury. British Journal of Psychiatry, 186, 60–66.
23.
HawtonK., & CatalanJ. (1987). Attempted suicide: A practical guide to its nature and management (2nd ed.). Oxford: Oxford University Press.
24.
HawtonK.ZahlD., & WeatherallR. (2003). Suicide following deliberate self-harm: Long-term follow-up of patients who presented to a general hospital. British Journal of Psychiatry, 182, 537–542.
25.
HjelmelandH. (1996). Verbally expressed intentions in parasuicide: II. Prediction of fatal and non-fatal repetition. Crisis, 17, 10–14.
26.
HjelmelandH., & KnizekB. L. (1999). Conceptual confusion about intentions and motives of nonfatal suicidal behavior: A discussion of terms employed in the literature of suicidology. Archives of Suicide Research, 5, 277–283.
27.
HjelmelandH.KnizekB. L., & NordvikH. (2002). The communicative aspect of nonfatal suicidal behavior: Are there gender differences?Crisis, 23, 144–155.
28.
HjelmelandH.NordvikH.Bille-BraheU.De LeoD.KerkhofJ. F. M.LönnqvistJ.MichelK.RenbergE. S.SchmidtkeA., & WassermanD. (2000). A cross-cultural study of suicide intent in parasuicide patients. Suicide and Life-Threatening Behavior, 30, 295–303.
29.
HjelmelandH.StilesT. C.Brille-BraheU.OstamoA.RenbergE. S., & WassermanD. (1998). Parasuicide: The value of suicidal intent and various motives as predictors of future suicidal behaviour. Archives of Suicide Research, 4, 209–225.
30.
HoT. P.YipP. S.ChiuC. W., & HallidayP. (1998). Suicide notes: What do they tell us?Acta Psychiatrica Scandinavica, 98, 467–473.
31.
JobesD. A.EymanJ. R., & YufitR. I. (1995). How clinicians assess suicide risk in adolescents and adults. Crisis Intervention and Time-Limited Treatment, 2, 1–12.
32.
JoinerT.RuddM. D., & RajabM. H. (1999). Agreement between self- and clinician-rated suicidal symptoms in a clinical sample of young adults: Explaining discrepancies. Journal of Consulting and Clinical Psychology, 67, 171–176.
33.
KesslerR. C.BorgesG., & WaltersE. E. (1999). Prevalence of and risk factors for lifetime suicide attempts in the National Comorbidity Survey. Archives of General Psychiatry, 56, 617–626.
34.
KingsburyS. J. (1993). Clinical components of suicidal intent in adolescent overdose. Journal of the American Academy of Child & Adolescent Psychiatry, 32, 518–520.
35.
LambertM. T. (2002). Seven-year outcomes of patients evaluated for suicidality. Psychiatric Services, 53, 92–94.
36.
LedewitzB. (2001). Mr. Carroll's mental state, or what is meant by intent. American Criminal Legal Review, 38, 71–109.
37.
MeanM.RighiniN. C.NarringF.JeanninA., & MichaudP. (2005). Substance use and suicidal conduct: A study of adolescents hospitalized for suicide attempt and ideation. Acta Paediatrica, 94, 952–959.
38.
MieczkowskiT. A.SweeneyJ.A.HaasG. L.JunkerB. W.BrownR. P., & MannJ. J. (1993). Factor composition of the Suicide Intent Scale. Suicide and Life-Threatening Behavior, 23, 37–45.
39.
MinkoffK.BergmanE.BeckA. T., & BeckR. (1973). Hopelessness, depression, and attempted suicide. American Journal of Psychiatry, 130, 455–459.
40.
MoscickiE. K. (2001). Epidemiology of completed and attempted suicide: Toward a framework for prevention. Clinical Neuroscience Research, 1, 310–323.
41.
MyersW. C.OttoT. A.HarrisE.DiacoD., & MorenoA. (1992). Acetaminophen overdose as a suicidal gesture: A survey of adolescents' knowledge of its potential for toxicity. Journal of the American Academy of Child and Adolescent Psychiatry, 31, 686–690.
42.
NegronR.PiacentiniJ.GraaeF.DaviesM., & ShafferD. (1997). Micro-analysis of adolescent suicide attempters and ideators during the acute suicidal episode. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 1512–1519.
43.
NimeusA.AlsenM., & Traeskman-BendzL. (2002). High suicidal intent scores indicate future suicide. Archives of Suicide Research, 6, 211–219.
44.
NiméusA.Träskman-BendzL., & AlsénM. (1997). Hopelessness and suicidal behavior. Journal of Affective Disorders, 42, 137–144.
45.
O'CarrollP. W.BermanA. L.MarisR. W.MoscickiE. K.TanneyB. L., & SilvermanM. M. (1996). Beyond the Tower of Babel: A nomenclature for suicidology. Suicide and Life-Threatening Behavior, 26, 237–252.
46.
O'DonnellI.FarmerR., & CatalanJ. (1996). Explaining suicide: The views of survivors of serious suicide attempts. British Journal of Psychiatry, 168, 780–786.
47.
OverpeckM. D., & McLoughlinE. (1999). Did that injury happen on purpose? Does intent really matter?Injury Prevention, 5, 11–12.
48.
PackmanW. L.PennutoT. O.BongarB., & OrthweinJ. (2004). Legal issues of professional negligence in suicide cases. Behavioral Sciences and the Law, 22, 697–713.
49.
PescosolidoB. A.GardnerC. B., & LubellK. M. (1998). How people get into mental health services: Stories of choice, coercion and “muddling through” from “firsttimers.”Social Science & Medicine, 46, 275–286.
50.
PierceD. W. (1977). Suicidal intent in self-injury. British Journal of Psychiatry, 130, 377–385.
51.
PierceD. W. (1981). The predictive validation of a suicide intent scale: A five year follow-up. British Journal of Psychiatry, 139, 391–396.
52.
PoesnerJ. A.LaHayeA., & CheifetzP. N. (1989). Suicide notes in adolescence. Canadian Journal of Psychiatry, 34, 171–176.
53.
RodhamK.HawtonK., & EvansE. (2004). Reasons for deliberate self-harm: Comparison of self-poisoners and self-cutters in a community sample of adolescents. Journal of the American Academy of Child & Adolescent Psychiatry, 43, 80–87.
54.
RuddM. D.JoinerT., & RajabM. H. (2001). Treating suicidal behavior: An effective, time-limited approach. New York: Guilford Press.
55.
SalterD., & PlattS. (1990). Suicidal intent, hopelessness and depression in a parasuicide population: The influence of social desirability and elapsed time. British Journal of Clinical Psychology, 29, 361–371.
56.
ShneidmanE. S. (1979). An overview: Personality, motivation, and behavior theories. In HankoffL. D. & HankoffE. B. (Eds.), Suicide: Theory and clinical aspects (pp. 143–163). Littleton, MA: PSG Publishing Co.
57.
SimonT. R.SwannA. C.PowellK. E.PotterL. B.KresnowM., & O'CarrollP. W. (2002). Characteristics of impulsive suicide attempts and attempters. Suicide and Life-Threatening Behavior, 32(Suppl.), 49–59.
58.
SuominenK.HenrikssonM.SuokasJ.IsometsäE.OstamoA., & LönnqvistJ. (1996). Mental disorders and comorbidity in attempted suicide. Acta Psychiatrica Scandinavica, 94, 234–240.
59.
SuominenK.IsometsaE.OstamoA., & LonnqvistJ. (2004). Level of suicidal intent predicts overall mortality and suicide after attempted suicide: A 12-year follow-up study. BMC Psychiatry, 4, Retrieved Jan. 25, 2006, from http://www.biomedcentral.com/content/pdf/1471-244X-4-11.pdf.
60.
TejedorM. C.DiazA.CastillonJ. J., & PericayJ. M. (1999). Attempted suicide: Repetition and survival—Findings of a follow-up study. Acta Psychiatrica Scandinavica, 100, 205–211.
61.
WagnerB. M.WongS. A., & JobesD. A. (2002). Mental health professionals' determinations of adolescent suicide attempts. Suicide and Life-Threatening Behavior, 32, 284–300.
62.
WetzelR. D. (1977). Factor structure of Beck's suicide intent scales. Psychological Reports, 40, 295–302.
63.
WiklanderM.SamuelssonM., & AsbergM. (2003). Shame reactions after suicide attempt. Scandinavian Journal of Caring Sciences, 17, 293–300.
