(PS11-26) Development and Validation of a Self-report Instrument Assessing Psychological Closeness to Suicide Methods

Background: Psychological closeness—defined by construal level theory as the perceptual proximity that one has to an object, event, or person—may be relevant to one’s practical capability for suicide. Psychological closeness to preferred suicide methods has been robustly linked to increases in suicidal intent, plans, and preparations over follow-up periods ranging from 2 hours to 1 month, with large effect sizes. However, initial studies were limited by unclear definitions of “psychological closeness” and the use of single-item measures. Thus, the present study aimed to refine the conceptualization of psychological closeness to suicide methods and develop and validate a brief self-report measure (i.e., the Psychological Closeness to Suicide Methods Scale [PCSMS]) to comprehensively assess this construct in research and clinical settings.

Methods: Audio-recorded interviews with 30 relevant stakeholders (i.e., 17 with lived experience of suicide, 18 clinicians working with suicidal patients, 10 suicide researchers; Sample 1) guided the (1) refinement of the conceptualization of psychological closeness to suicide methods and (2) the generation of an initial pool of 54 items assessing this construct. These items and other validated measures were administered to 489 college students (Sample 2) and 278 community members (Sample 3) with current suicidal ideation and/or a lifetime suicide attempt to validate the PCSMS.

Results: Content analysis of the interviews revealed three themes—familiarity, comfort, and attachment—which were used to guide item generation. An exploratory factor analysis approach identified the dimensionality (5 factors) of the items, and multidimensional item response theory analyses reduced the initial item pool from 54 items to 19 discriminative and non-redundant items across the five subscales (i.e., sentimental/emotional connection, attempts to avoid, familiarity/knowledge, use for emotion regulation, and mental attachment/fixation). Differential item functioning analyses indicated that the items performed comparably across those with varying suicide attempt histories. In general, the PCSMS subscales correlated with other scales in expected directions. Sentiment, avoidance, regulation, and fixation on preferred methods were uniquely associated with severity of suicidal ideation, whereas familiarity with preferred methods was uniquely associated with a history of suicide attempts.  

Conclusions: The PCSMS, developed through a mixed methods approach, can be reliably and validly used to assess facets of psychological closeness to suicide methods. These findings should be replicated in various populations (e.g., Veterans) and longitudinally to establish the generalizability and predictive validity of the scale.