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Running head: ASSESSMENT REVIEW PROJECT

Linsdale Graham

Assessment Review Project

Bridgewater State University


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Assessment Review Project

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

of current suicide ideation, hopelessness, negative self-evaluation and hostility. Respondents

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,

affects the scoring and amount of information gathered in the results.

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

risk includes subscales such as self-esteem vulnerability, overinvestment, overdetermined

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

consistent despite the external variables that may affect it.

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

Title The Suicide Assessment Scale Life Orientation Inventory


General Info A brief self-report measure
designed to aid in the
assessment of suicide risk in
adolescents and adults.

Authors John G. Cull, Pd.D and Wayne John D. King and Brian
S. Gill, Ph.D Kowalchuk

Publisher Western Psychological Pearson Services


Services
Date of 1982 1988
Publication
Forms
Groups applicable Individual and Groups Individual and small groups
to
General Type
Practical Features

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.

Training required Person must be trained or a


to administer paraprofessional functioning
under the supervision of a
trained professional.

Technical Only Available in Paper Only Available in Paper Format


Considerations Format
Purpose and Used to assess suicide risks in Used to predict what stage of
Nature of adolescents and adults suicide someone presents
Instrument
Description of test 36-items
Items and scoring 4 point likert scale ranging
from “none or a little of the
time” to “most or all of the
time”

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A total weighted score


Reliability Internal reliability for the According on the King and
Validity subscales is generally adequate Kowalchuk 1994 study, the test-
with Cronbach alpha efficient retest reliability over 3 to 4 days
ranging from .62 to .89. The SPS was 0.80 for the total score and
has high test-retest reliability over 0.70 for the critical items of the
a three-week period (r = .92; Cull ISO-30. Also, dependent on the
& Gill, 1988 same study, the internal
consistency for a clinical and
student sample of adolescents was
0.90 showing high reliability. Test
from the same samples, the
concurrent validity was calculated
to be .64 and 0.52 when correlated
with the SIQ instrument; .55 and
.78 with the SIQ-JR version.

Cross Cultural Not very culturally sensitive Not cross culturally fair
Fairness

Practicality Very practical as an initial Very time consuming due to


assessment specific protocols in
administration
Aids to Users Paper Manual Paper Manual
References

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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.

Lillian M. Range (2005). The Family of Instruments That Assess Suicide


Risk. Journal of Psychopathology and Behavioral Assess ment, Vol.27, No.2.

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