[Suicidal Risk Scale]

E Granier, J Ph Boulenger
L'Encéphale 2002, 28 (1): 29-38
Assessment of para-suicidal patients is one of the main tasks for the practitioner in an emergency unit. There are now any characteristics known as suicide risk factors, like drug or alcohol abuse, past history of suicides in the family, or psychiatric disorder. However though these characteristics are useful to define high-risk populations, they are not always relevant in personal assessment. The more relevant variables in this case are psychological. Unfortunately, there are very few assessment scales in this area, since scales are usually related to the prediction of suicide or para-suicide before the act. The only existing tool for assessment after the act is the Beck Suicidal Intent Scale (SIS, 1974), which assesses the wish to die. Therefore we propose a new scale for a global assessment of parasuicide: it is an eleven-items scale, divided in four sections. Each section assesses: (1) the parasuicide itself, with the wish to die, the way to die and precautions against intervention; (2) the patient himself, with the premeditation level, an affective disorder existing before the act, the means of future, and environment effect (in a sense of protection or risk); (3) the global impression after the psychiatric interview: the emotionalism level, and the trust in the patient attitude; (4) the patient history: alcohol or drug abuse, personal past-parasuicide. The scale construction was empirical, from clinical practice, but it encompasses the nine high-risk variables found by Motto and Bostrom (1990) in an analysis of prospective data from 3,005 psychiatric patients at risk for suicide, focusing on 38 persons who committed suicide within 60 days of evaluation. Our study has been conducted on a 77 sample of para-suicidal patients in the psychiatrist emergency unit of the Avignon Hospital. For each patient, the score from our scale was calculated by psychiatric nurses after their own interview, before psychiatric examination, about 12 or 24 hours after the entrance in the emergency unit. Then, patients were classified in four groups according to the psychiatrist decision and orientation: exit (n = 7), consultation (n = 34), hospitalization (n = 24), hospitalization under constraint (n = 12). These groups mean theoretically an increasing global gravity: it is possible for example to hospitalize a parasuicidal patient because he wants to die, even without depression. Or in an other case, if he has a very serious psychiatric disorder (for example affective or psychotic), with a low-lethality para-suicide. Moreover, for a 22 sub-sample patients, the score from Beck-SIS was also calculated. The scale scores comparison in the four groups were made by analysis of variance: there was a statistically significant difference between groups as whole and individually (p < 0.001). In the second analysis, we defined two subsamples: the first one contains the hospitalized patients (n = 36) and the second one, the non-hospitalized (n = 41) patients. Statistically, from the scale scores, it was possible to define a threshold above which all the patients were hospitalized, and an other one under which all patients were not hospitalized. Third, there was a good correlation between lethality scores in our scale (first section) and the Beck SIS scores (r = 0.91). In conclusion, our scale seems to be well correlated with global gravity meant by parasuicide, to assess correctly suicidal intent, and to provide reliable indicators for hospitalization. However, some aspects are still missing in this study: we did not compare any sub-score with other well-known scales, assessing depression or hopelessness. On the other hand, we couldn't obtain prospective data on all the patients after their parasuicide. The following steps will be to carry on with these studies, as well as with the replication of our results on larger samples.

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