Assessing the lethality of suicide attempts: Adding chance of rescue to medical severity.

ABSTRACT Introduction: Emphasis on medical severity when assessing the lethality of suicide attempts may overlook important contextual factors. We examined if distinguishing between medical severity and chance of rescue improves evaluation and understanding of suicidal mental states. Methods: Seventy adolescent inpatients with a recent suicide attempt were interviewed with the Suicide Intent Scale, and clinicians rated the Risk-Rescue Rating Scale, which provides separate ratings for medical severity (Risk) and chance of rescue (Rescue). They also completed the Interpersonal Needs Questionnaire and Fearlessness about Death scale. Results: The lethality components Risk and Rescue were uncorrelated (r = −0.02). However, Rescue was significantly negatively correlated with suicidal intent (r = −0.46), fearlessness about death (r = −0.29), and unmet interpersonal needs (r = −0.28), while Risk was only correlated with suicidal intent (r = 0.29). In a hierarchical regression model, Rescue was the strongest predictor of suicidal intent. Conclusion: Rescue factors, more than medical severity factors, were consistently related to our measures of suicidal mental state. Including the rescue component in lethality assessments may improve both the accuracy of clinical evaluations and our understanding of adolescents' mental state during suicidal crisis.