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Is There Value in Asking the Question "Do you think you would be better off dead?" in Assessing Suicidality? A Case
Jennifer M Giddens1, David V Sheehan1
1J. Giddens is the Co-founder of the Tampa Center for Research on Suicidality, Tampa, Florida; and Dr. Sheehan is Distinguished University Health Professor Emeritus, University of South Florida College of Medicine, Tampa, Florida.
Objective:
The author of the widely used suicidality scale, the Columbia-Suicide Severity Rating Scale, has repeatedly made the claim that asking the question, "Do you think you would be better off dead?" in suicidality assessment delivers false positive results. This case study investigates the value of this question as an immediate antecedent to impulsive suicidality and as a correlate of functional impairment.
Method:
One subject with daily suicidality and frequent impulsive suicidality rated five passive suicidal ideation phenomena and impulsive suicidality daily on a 0 to 4 Likert scale and rated weekly functional impairment scores for 13 weeks on a 0 to 10 Discan metric.
Results:
Each of the five passive suicidal ideation phenomena studied frequently occurred at a different severity level, and the five phenomena did not move in synchrony. Most passive suicidal ideation phenomena were very low on dates of impulsive suicidality. Thoughts of being better off dead were a frequent antecedent to impulsive suicidality and were related to an increase in functional impairment.
Conclusion:
The relationship to both functional impairment and impulsive suicidality suggest that it is potentially dangerous to ignore thoughts of being better off dead in suicidality assessment.