A psychometric study of the Suicide Cognitions Scale with psychiatric inpatients

The cognitive model of suicide makes specific predictions about the role of cognition in suicide risk. This study examined psychometric properties of the Suicide Cognitions Scale (SCS), an instrument designed to measure suicide-specific cognitions, in a sample of 150 patients (age range, 18-75 years, SD = 14.42; 56% female, 94% White) hospitalized for suicide risk associated with multiple, treatment-resistant psychiatric conditions. Findings revealed strong psychometric properties, including internal consistency and test-retest reliability. Incremental validity beyond depression and hopelessness was demonstrated in the prediction of suicidal ideation. Confirmatory factor analysis examining previously reported factor solutions suggested more consistency with a three-factor solution (Unlovability, Unbearability, and Unsolvability) relative to a two-factor solution. Good sensitivity to treatment response over the course of hospitalization also was demonstrated. The hypothesis of residual risk, derived from cognitive theory and predicting that lack of change in suicide schemas would be associated with higher suicide risk at discharge, was supported. Overall, these findings suggest considerable promise for the SCS as a measure of suicide risk that adds predictive utility to measures of depression and hopelessness, with potential usefulness in planning and monitoring treatment for suicidal individuals.