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The results of this study are important for a number of reasons, particularly given recent findings using traditional screening and assessment tools like the C-SSRS, and others asking direct and specific questions about suicide. It's not just about another scale assessing suicidality, it's about how these items assess suicidality by targeting core beliefs about self and enduring risk around three themes of unbearability, unlovability and unsolvability, without asking directly about suicide. Recent findings using the C-SSRS reveal a broader problem with direct assessment of suicide risk. As with many instruments assessing suicidality in direct and specific fashion, the C-SSRS demonstrated poor predictive value in two studies with very large samples in healthcare settings (Simpson, Loh, & Goans, 2021). There is emerging data to support the conclusion that a large percentage of patients in healthcare and clinical settings are either unwilling or unable to reveal active suicidal thoughts and motivation to die when answering direct questions (Rudd, 2021).
It's not that we need better screening tools. We need to recognize the limited predictive value of tools that assess suicidality in direct and specific ways. We need tools that complement these traditional approaches, adding unique predictive power. Additionally we need approaches that recognize that there are great and frequent variations in suicidal thinking for many, as ecological momentary assessment studies are illustrating, and that many existing tools are simply not sensitive to such profound and frequent shifts in suicidal thoughts. It is also important to recognize that there are some elements of enduring risk that are simply missed by traditional screening approaches. These findings confirm that a few items targeting underlying core beliefs about self, revolving around the themes of unlovability, unbearability, and unsolvability can add meaningful power to our ability to understand, anticipate and target individual vulnerability for suicide risk. I would suggest we need more work like this and continued innovation targeting how best to assess and understand enduring vulnerability for suicide.