Understanding the Response to Suicidal Ideation in Young Adults: Development and Initial Validation of the Response to Suicidal Ideation Inventory (RSII)

Abstract

Suicidal ideation (SI) is relatively prevalent in youth (Kleiman et al., 2017) and 20-33% of youth will escalate from SI to suicidal behaviours (Mortier et al., 2018; Nock et al., 2013). Youth with a history of SI tend to report low-to-moderate self-efficacy for coping during a suicide crisis (Czyz et al., 2016) and fewer than half of youth access mental health services when experiencing SI (Hom et al., 2015). However, cognitive and behavioral responses to SI episodes are not well understood and there are no tools available for assessing how individuals respond to their SI. The current study aimed to (1) develop a questionnaire, the Response to Suicide Ideation Inventory (RSII), to quantify how youth with a history of SI respond behaviorally and cognitively to SI episodes and (2) conduct an initial exploration of the psychometric properties of the measure. In Phase I, I generated items and instructions based on literature reviews, consultation with content experts, and aggregating information from online communities and resources. In Phase II, 491 participants completed the RSII and questionnaires measuring general coping, history of suicidal thoughts and behaviours (STBs), emotion dysregulation, suicide resilience, and future expectancies of STBs engagement. Exploratory factor analysis (EFA) of the data revealed that a 43-item scale with seven factors (i.e., Considering Consequences of Suicide, Suicide Planning, Pleasant Activities, Risky Behaviours, Seeking Emotional Support, Behavioural Distraction, and Cognitive Distraction) was representative of the underlying cognitive and behavioural dimensions of the response to SI. In general, the overall RSII measure and its subscales showed acceptable reliability. Participants also expressed support for the face and content validity of the scale. The overall RSII measure demonstrated some convergence with general coping and divergence from emotion dysregulation, suicide resilience, and expectancies of future STBs. Analyses also preliminarily supported concurrent validity; some of the RSII’s factors were associated with STB severity and frequency, as well as suicide resilience, in expected directions.