Menninger Study Examines Use of Suicide Index Score to Identify Risk Groups, Assess Suicide Risk over Time

Monday, July 8, 2013
Suicidal thoughts and behaviors constitute a complex, often confounding topic for researchers and mental health clinicians alike. Understanding how to treat patients who have considered or attempted suicide is a research priority for Thomas Ellis, PsyD, ABPP, director of Psychology at The Menninger Clinic.
One contribution he’s made to the field of suicide research is as co-author of “Using the Suicide Index Score to Predict Treatment Outcomes among Psychiatric Inpatients,” a paper recently published by Suicide and Life-Threatening Behavior, the journal of the American Association of Suicidology.
For the paper, Dr. Ellis and his co-authors examined results from 32 patients’ Suicide Index Score (SIS), taken at admission to Menninger and then at two-week intervals throughout inpatient treatment. The SIS was used to classify patients into three categories – wish-to-live (WTL), wish-to-die (WTD) and ambivalent (AMB) – and examined of the three groups’ response to treatment over time.
“Not all suicidal patients are the same,” said Dr. Ellis. “Some make very serious suicide attempts, while others report that they really don’t want to die, even if their behavior may make it look as if they do. With this study, we wanted to see whether assessing the strength of a patient’s wish to die might be an important aspect of understanding and helping that patient.”
According to Dr. Ellis, this is the first time that the SIS has been used to examine how patients’ scores on measures of depression and suicidality change over time.

Patient characteristics

There were 32 Menninger inpatients in the final sample size. Patients ranged in age from 19 to 67 years old, and 75 percent had attempted suicide at least once. All entered Menninger with active suicide ideation and/or a suicide attempt within the previous year.
With respect to diagnoses, 28 of the patients were diagnosed with primary mood disorders, including major depression, depressive disorder not otherwise specified, bipolar I disorder and bipolar II disorder. The other participants had primary diagnoses of bulimia, panic disorder, anxiety disorder not otherwise specified or posttraumatic stress disorder. The average length of stay was 55 days.
The study data was gathered from these patients’ enrollment in a larger trial of the Collaborative Assessment and Management of Suicidality (CAMS) protocol, which is “an evidence-based suicide-focused treatment framework” developed by David Jobes, PhD, of The Catholic University of America. Patients in the study received two, 50-minute therapy session each week from therapists trained in the CAMS approach.


Of the patients studied, 15 (47 percent) patients’ SIS score put them in the WTL group, 9 (28 percent) in the AMB group and eight (25 percent) in the WTD group.
Patients in the WTL group “reported subclinical levels of suicidal ideation and depression within three to five weeks of CAMS treatment and inpatient care.” Patients in the WTD group also achieved similar results. Those in the AMB group, however, “were the only group still reporting clinically significant levels of suicidal ideation at six weeks into CAMS treatment.”

Real-world impact

With the patients in the WTL and WTD groups achieving symptom relief, Dr. Ellis said the concern remains those patients in the AMB group and how clinicians can best address their particular needs.
“We don’t yet understand how this group is different, but the data show we need to examine their characteristics in new ways so that we can begin to really help them,” Dr. Ellis explained. “Focusing on the issue of ambivalence in therapy may be one way to engage them and improve their outcomes.”
In the meantime, the study indicates “the SIS appears to predict patients’ depression and hopelessness levels at different points in treatment, both of which are constructs heavily linked to suicide.” As such, Dr. Ellis said it may be prove to be a useful assessment tool for clinicians who are concerned about accurately evaluating a patient’s suicide risk.