The revised suicide crisis inventory (SCI-2): Validation and assessment of prospective suicidal outcomes at one month follow-up

The Suicide Crisis Syndrome (SCS) is an evidence-based pre-suicidal cognitive and affective state predictive of short-term suicide risk. The most recent SCS formulation, proposed as a suicide-specific DSM diagnosis, features a feeling of Entrapment accompanied by four additional symptom clusters: Affective Disturbance; Loss of Cognitive Control; Hyperarousal; and Social Withdrawal. The aim of the present study was to revise the Suicide Crisis Inventory (SCI; Barzilay et al., 2020), a self-report measure assessing the presence of SCS, in accordance with the current SCS formulation as well as to assess the psychometric properties and clinical utility of its revised version, the Suicide Crisis Inventory—2 (SCI-2).
Methods
The SCI-2, a 61-item self-report questionnaire, was administered to 421 psychiatric inpatients and outpatients at baseline. Prospective suicidal outcomes including suicidal ideation, preparatory acts and attempts were assessed after one month. Internal structure and consistency were assessed with confirmatory factor analysis, convergent, discriminant, and current criterion validity. Receiver-operating characteristic (ROC) curves with Area Under the Curve (AUC) were used to examine the predictive validity of the SCI-2 to prospective outcomes. Exploratory analyses assessed the predictive validity of the five SCI-2 dimensions.
Results
The SCI-2 demonstrated excellent internal consistency (Cronbach’s α=.971), good convergent, discriminant, and current criterion validity. The SCI-2 significantly predict all three outcomes, and was the only significant predictor of attempts with AUC= .883.
Discussion
Our findings validated the SCI-2 as an effective measurement of short-term prospective preparatory acts and attempts in a large, diverse sample of psychiatric inpatient and outpatients. The results of this study indicate that the SCI-2 is a valid and reliable tool to assess the presence and intensity of the Suicide Crisis Syndrome and to predict short-term prospective suicidal behaviors and attempts among psychiatric outpatients and inpatients regardless of patients’ readiness to disclose suicidal ideation.