Professional Documents
Culture Documents
Linsdale Graham
Mental Health and wellness is so important for all aspects of life, but often goes
unnoticed. Not taking inventory into mental wellness as we face life’s adversities has resulted in
many feeling desperate and hopeless in relation to mental relief. In these moments of despair and
pain, many perceive suicide as the only way to stop the hurt. According to the American
Foundation for Suicide Prevention, it is the 10th leading cause of death in the United States and
roughly 45,000 annually will die from suicide. These statistics are staggering to fathom but
paints not only the reality but the necessity for added measures in trying to prevent this
occurrence. While prevention and assessing, risk is complex given that persons normally suffer
in silence, assessment tools have been proven to be effective in helping to monitor and track
mood changes as they encounter life events. One of the main assessment tools in suicide has
been the Beck’s Scale for Suicide Ideation. While effective, there has been the need for more
variety and more comprehensive assessments to be readily available. In this paper, I will
compare two suicide assessments available at the Resource Center at The Maxwell Library at
Bridgewater State University. Suicide Probability Scale and Life Orientation Inventory both
offer options in assessing for suicide. A general comparison will be done assessing the
practicality of the instruments, as well as the reliability and validity and the overall usefulness for
clinicians.
The Suicide Probability Scale (SPS; Cull & Gill, 1988) is a 36-item self-report measure
answer each item on a 4-point scale ranging from 1 (“None or a little of the time”) to 4 (“Most or
all of the time”). There are three summary scores: A Suicide Probability Score, a total weighted
score and a normalized T-score. The Suicide Probability Score can be adjusted to reflect
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different a priori base rates for particular clinical populations. The SPS scale takes approximately
10 minutes to administer. While the Life Orientation Inventory (LOI; Kowalchuk & King, 1988)
is a little more specific in assessing how far a person has advanced in the suicide process
regardless of age, gender, stress level or previous behavior. It is divided into six sections,
labelled A-F. These sections all deal with some subgroup of the opinions regarding oneself, love,
work and what is important to me, getting what I want, reacting to situation, being with other
people and reasons for living or dying. These sections have varying amount of questions starting
with 24 and the least being 8. With a scale for each question that goes from ‘I am Sure I
disagree’ to ‘I am sure I agree’. Both assessments offer basic functionality in relation to the ease
of completing. The LOI is a little more comprehensive in the amount of items and as a result,
One of the major differences of the two assessments is the initial intention behind it. The
SPS (1988) is used to measure current feelings and as a result would be most effective as an
initial assessment. While the LOI, while it also measures the likelihood of an attempt, it was
birthed out of a theory regarding the various stages of suicide. This framework has guided the
development of this assessment in looking at not only suicidal ideation but an overall risk. This
misery, affective domination, alienation, suicide tenability. Similar to the LOI and the subscales,
the SPS has four clinical subscales: Hopelessness, Suicidal Ideation, Negative Self-Evaluation,
and Hostility. Both assessments anticipate an estimated time for completion, the SPS anticipates
10 minute to complete and another 10 minute to score. On the contrary, the LOI is much more
detailed and estimate about 30 minutes to complete and another 20-30 minutes to score.
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Another major difference in the assessments is the level of training and preparation required for
these assessments. The SPS is a little simpler as seen in the time estimated, because the
instructions are not as regimented or specific. It basically calls for trained professionals and
paraprofessional working under the training of supervisors. The administration of this assessment
is not strict or perhaps the assessment manual simply did not mention certain things. However,
the LOI is very specific in the training necessary of the administrators of this assessment. It is
specific in mentioning the type of environment in which this can be used from the comfortability
of the clients to the role of the administrator. This clear distinction in the role was something that
was notably different with both assessment manuals. The SPS does not give much detail but the
LOI emphasized following a strict script and reading directions verbatim. Offering help but only
in relation to confirming or denying certain queries. For example, the LOI handbook highlights
the importance of hearing the interpretation for the clients and agreeing with whatever their
interpretation is and only clarifying if their interpret the opposite of what it is actually asking. In
addition to that, the administrators must be fully familiar with the LOI and its manual. This was
vividly different in the level of instruction provided in the SPS manual. The varying degrees of
instructions and specificity could be comforting for an administrator or could be very anxiety
provoking concerning the severity of the possible impact of this assessment on verifying risk.
However, what was common among both is the importance of not using any of the assessments
as solitary tools but rather supplementary to clinical judgement and interviews and other clinical
observations.
Verifying the reliability and validity of any assessment is of utmost importance. The
reliability refers to the consistency with which an instrument measures something. First, the
internal reliability for the SPS is high (Cronbach alpha = .93). Internal reliability for the
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subscales is generally adequate with Cronbach alpha efficient ranging from .62 to .89. The SPS
has high test-retest reliability over a three-week period (r = .92; Cull & Gill, 1988). The SPS has
differentiated among normal, psychiatric inpatients and suicide attempters (Cull & Gill, 1988).
The SPS total score and subscales were positively Suicide Assessment 12 correlated with the
Depression (rs = .44 to .73), Psychopathic Deviate (rs = .48 to .63), Paranoia (rs = .47 to .61) and
Schizophrenia (rs = .56 to .68) scales of the MMPI (Cull & Gill, 1988). In addition, SPS total
score was moderately correlated (rs = .67 to .71) with the Suicide Threat Scale that was
developed for the MMPI (Farberow & DeVries, 1967). Suicide probability was correlated with
irrational beliefs (Woods, Silverman, Gentilini, Cunningham, & Grieger, 1991). The total SPS
scale was significantly associated with the Social Problem Solving Scale, the Beck Hopelessness
Scale and the Beck Depression Inventory in college students and adult psychiatric inpatients
(D’Zurilla, Chang, Nottingham, & Faccini, 1998). This comprehensive evaluation of the SPS by
D,Zurilla et. al. provides a very clear indication of the level of test and retest done prior to ensure
that as a diagnostic tool, it was solid. Similarly, the LOI was tested for internal consistency using
Cronbach’s (1951) coefficient alpha. For an instrument like the LOI to be considered minimally
reliable, the coefficients must equal or exceed .80 and based on table 5 (LOI manual) both the
scales and subscales had coefficients well exceeding .80 ranging from .92 to .95. Showcasing a
high rate of consistency and thus adding to the reliability. There was also a test and retest done
using a temporal stability test which proved successful. Of a sample of students divided into high
and low self-reported stress levels, these groups were both tested and scores recorded. This
comparison showcased that there was no statistically significant differences in the scores
reported using the assessment. This was after consecutive tests given at intermittent times were
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administered. This test and retest showcased further how reliability of this assessment tool. Also
for the content and construct validity relating to the LOI, the results were all above the standard.
This is very reassuring for both assessments to be considered both reliable and valid. This helps
to put practitioners choosing to administer these tools to be assured that regardless of some
factors, these tools will not only test the same thing every time but the results will be fairly
In summary, both the SPS and the LOI are both reliable and valid as measurement
instruments. They are both trusted in its effectiveness of not only helping to predict suicide risk,
but also highlighting areas of concern that a clinician can utilize in developing a treatment plan.
Additionally, both assessments offer an added layer of protection in helping to safe guard the
safety and wellbeing of clients. One of the biggest differences were the level of detail provided
in the LOI manual and the precise instruction given regarding the administration. These
differences and similarities can either be strengths or weaknesses depending on the clinician
personal styles and theoretical orientations. Personally, I am more inclined to the SPS because it
is more user friendly and does not require as much structure, this allows for me to have some
flexibility in its usage and not jeopardize the utility of it. While there are both pros and cons of
each of these assessments, the underlying commonality is that as assessment tools, they cannot
and should not be used solitary but rather supplementary to clinical interviews and observations.
Assessments should also be used in conjunction with other diagnostic and clinical tools.
Assessments in helping to not only predict but assess risks factors regarding suicide are very
vital to this issue. Continual research and further development is necessary for both assessments,
in addition to more tests made applicable to other cultures as both were not as culturally flexible.
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General Info
Authors John G. Cull, Pd.D and Wayne John D. King and Brian
S. Gill, Ph.D Kowalchuk
Cost
Time required for Entire scale can usually be Thirty minutes is required to
Administration administered, scored and complete the 30-item survey
interpreted in less than 20 using a 4-point rating scale.
minutes.
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Cross Cultural Not very culturally sensitive Not cross culturally fair
Fairness
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References
Piersma HL and Boes JL (1997). Utility of the Inventory of Suicide Orientation -30
(ISO-30) for adolescent psychiatric inpatients: linking clinical decision making
with outcome evaluation. Journal of Clinical Psychology, 53(1):65 -72.
Davids M. Reith and Liza Edmonds (2007). Assessing the Role of Drugs in
Suicidal Ideation and Suicidality. CNS Drugs. 21(6):463-472.