Suicidal behavior represents one of the most critical public health challenges and clinical emergencies encountered across psychiatric, medical, and psychological disciplines. A suicide attempt is fundamentally defined as a non-fatal, self-directed, and potentially injurious behavior accompanied by an explicit or implicit intent to die as a result of that behavior. Understanding the multifaceted architecture of an attempted suicide demands an integrative examination of neurobiological vulnerabilities, psychopathological mechanisms, acute cognitive states, and sociocultural determinants.
Attempted Suicide
1. Concise Definition
An attempted suicide, or non-fatal suicide attempt, is a self-inflicted, potentially injurious behavior for which there is evidence—either explicit or inferred—that the person had at least some degree of intent to end their own life. Although the physical outcome does not culminate in death, the behavior is demarcated from other non-fatal self-injuries by the presence of a subjective volition toward self-annihilation.
In psychiatric taxonomy and public health surveillance, clarifying this construct is vital for distinguishing lethal intention from behavior that lacks such purpose. The World Health Organization and regulatory bodies such as the Centers for Disease Control and Prevention emphasize that injury or tissue damage is not a mandatory prerequisite for classification; rather, engaging in a potentially lethal act with an active desire or expectation of death constitutes an attempt, regardless of whether anatomical harm occurs or medical intervention is required.
2. Etymology & Linguistic Origin
The noun suicide derives from Modern Latin suicidium, formed by conjoining the Latin reflexive pronoun sui (meaning “of oneself”) and the combining form -cidium (derived from the verb caedere, meaning “to strike, beat, or kill”). The word first emerged in seventeenth-century English scholarly literature, notably in Sir Thomas Browne’s philosophical treatise Religio Medici (circa 1642), where it was introduced to provide an objective, neutral linguistic alternative to criminalized and stigmatizing Anglo-Saxon and Middle English idioms such as “self-murder” or “felo-de-se” (felon of oneself).
The qualifier attempted originates from the Middle English atempten, which entered the language via Old French atempter and roots directly in the Classical Latin verb attemptare or adtemptare (“to try, strive, test, or attack”), composed of the directional prefix ad- (“to, toward”) and temptare (“to handle, touch, or test”). When fused within medical and legal jurisprudence during the nineteenth century, “attempted suicide” initially functioned within common-law systems as a prosecutable criminal offense before evolving into an exclusively medicalized, psychiatric diagnosis signifying an acute crisis requiring specialized psychological containment.
3. Pronunciation & Grammatical Form
In standard International Phonetic Alphabet (IPA) transcription, the term is pronounced as /əˈtɛmptɪd ˈsuːɪsaɪd/ in standard British English and /əˈtɛmptɪd ˈsuːəˌsaɪd/ in General American English. Grammatically, the compound noun “attempted suicide” functions as a countable noun referring to an individual historical episode or clinical event (e.g., “the patient survived a serious attempted suicide”), while also frequently serving as an uncountable nominal phrase referring broadly to the behavioral phenomenon within epidemiological research.
The adjectival past-participle form “attempted” modifies the primary noun “suicide.” Over recent decades, contemporary suicidology has increasingly shifted toward person-first and clinically objective nomenclature. Authoritative style manuals and professional organizations advocate using the nominal phrase “suicide attempt” rather than “attempted suicide,” and recommend verbs such as “to attempt suicide” or “to survive a suicide attempt” while strongly deprecating archaic, morally laden phrases like “committing suicide” or “successful versus unsuccessful attempt.”
4. Detailed Conceptual Explanation
A comprehensive understanding of an attempted suicide requires parsing the essential cognitive, affective, and behavioral parameters that delineate the phenomenon. Central to any rigorous clinical conceptualization is the variable of suicidal intent. Intent is characterized by an individual’s subjective conviction that their act will result in their death, even if their understanding of physiological lethality is objectively inaccurate. Consequently, a person who ingests a sub-therapeutic dose of a relatively harmless compound under the firm belief that it is an invariably fatal toxin possesses genuine suicidal intent, qualifying the act as an attempted suicide despite minimal physical sequelae.
Conversely, physical lethality evaluates the objective medical severity of the somatic trauma inflicted, irrespective of subjective intention. The dynamic interplay between lethality and intent creates distinct clinical phenotypes. Some individuals display high intent yet survive due to algorithmic rescue, physiological resilience, or miscalculated pharmacokinetics; others may manifest ambiguous or ambivalent intent while employing profoundly lethal means that result in catastrophic physical morbidity. Clarifying this discrepancy is crucial, as post-attempt psychological evaluations consistently reveal that individuals who experience an attempt often report states of profound cognitive narrowing, tunnel vision, and cognitive constriction—a phenomenon where dying is perceived as the sole available remedy for unbearable psychological pain, termed “psychache.”
Beyond intent and lethality, the duration of deliberation marks another vital diagnostic boundary. Research reveals a heterogeneous continuum ranging from meticulously planned acts—characterized by the drafting of final wills, writing of farewell notes, active evasion of discovery, and procurement of specific means over weeks—to impulsive attempts occurring within minutes of an acute interpersonal catastrophe. Nonetheless, empirical studies indicate that even ostensibly impulsive attempts typically occur against a background of chronic diathesis, affective instability, cognitive distortion, and longstanding emotional distress.
Finally, a major conceptual challenge involves mapping the threshold between an interrupted attempt and an aborted attempt. In an interrupted attempt, the individual initiates the behavioral trajectory toward self-destruction (such as positioning themselves to jump or holding a weapon) but is stopped by an external force or third party before actual physical damage occurs. In an aborted attempt, the individual halts the sequence purely through internal volitional control before mechanical harm transpires. Both manifestations indicate severe suicidal crisis and represent potent empirical markers of near-term morbidity, warranting urgent intervention similar to that administered after an attempt resulting in physical hospitalization.
5. Historical Development
The philosophical, legal, and medical conceptualization of attempted suicide has undergone dramatic shifts across centuries of human civilization. In classical antiquity, attitudes toward self-destruction were nuanced and contingent upon social station and philosophy. Stoic thinkers, such as Seneca and Epictetus, viewed rational self-termination as an honorable preservation of personal agency in the face of inevitable degradation, tyranny, or incurable somatic agony. Conversely, the Athenian polis often enacted post-mortem sanctions, and Aristotle condemned self-inflicted death as an act of cowardice that deprived the state of a productive citizen.
With the rise of the Christian theological synthesis in medieval Europe, self-inflicted death was definitively recategorized as an irredeemable mortal sin. Promoted prominently by St. Augustine in De Civitate Dei and later systematized in Thomas Aquinas’s Summa Theologiae, suicide was framed as a direct violation of the Sixth Commandment, a usurpation of God’s sovereignty over life, and an offense against nature. Under secular and ecclesiastical legal frameworks, attempted suicide was codified as a criminal act of treason against the crown or God. Individuals surviving an attempt faced severe corporal punishment, imprisonment, confiscation of familial estates, and subsequent denial of consecrated burial rituals upon natural death.
The eighteenth-century Enlightenment initiated a fundamental paradigm shift. Philosophers such as David Hume challenged theological dogmatism, arguing that an individual’s life belongs to themselves rather than the state or clergy. By the nineteenth century, the burgeoning discipline of alienism—the forerunner of modern psychiatry—began to reclassify suicidal behavior as an expression of mental alienation, melancholia, and physiological imbalance rather than moral depravity. French alienist Jean-Étienne Dominique Esquirol asserted that all suicidal acts were symptoms of underlying mental alienation, setting the stage for subsequent psychiatric classification.
A monumental turning point occurred in 1897 with the publication of Émile Durkheim’s landmark sociological study Le Suicide. Durkheim demonstrated that suicidal actions were not merely idiosyncratic psychological aberrations, but social phenomena governed by structural integration and moral regulation within society, introducing structural classifications such as egoistic, altruistic, anomic, and fatalistic suicide. In the mid-twentieth century, the establishment of formal suicidology by figures such as Edwin Shneidman, Norman Farberow, and Robert Litman—who co-founded the Los Angeles Suicide Prevention Center in 1958—solidified non-fatal suicidal behaviors as a distinct, specialized focus of psychological investigation and community intervention.
6. Theoretical Foundations
The systematic study of attempted suicide has yielded several robust psychological frameworks that explain how ideological despair translates into active self-directed violence. Early psychoanalytic frameworks proposed by Sigmund Freud conceptualized suicide as internalized aggression, wherein intense host-directed hostility is turned backward against the ego via identification with an ambivalently loved object (Thanatos or the death drive). In contrast, Edwin Shneidman pioneered psychological models centering on “psychache”—a condition of intolerable, agonizing psychological pain generated by frustrated vital psychological needs. Shneidman asserted that suicide is not an attraction to death per se, but rather an escape from relentless inner torment.
In modern cognitive-behavioral science, Aaron Beck formulated the cognitive triad of depression and highlighted hopelessness as the primary psychological mediator connecting affective despair to suicidal intent. Beck’s cognitive therapy paradigm posited that pervasive cognitive schemas of helplessness, unlovability, and unchangeability generate a psychological state where self-destruction appears entirely rational to the individual.
Over the past two decades, contemporary suicidology has been dominated by “ideation-to-action” frameworks, which emphasize that the factors responsible for generating suicidal thoughts are distinct from those that enable an individual to enact those thoughts. Foremost among these is the Interpersonal Theory of Suicide formulated by Thomas Joiner. Joiner postulates that suicidal desire develops through the intersection of two distinct psychological constructs: thwarted belongingness (the perception of being fundamentally alienated and disconnected from others) and perceived burdensomeness (the catastrophic belief that one’s existence is an intolerable liability to family, friends, or society).
Crucially, Joiner’s theory asserts that the presence of thwarted belongingness and perceived burdensomeness, even when accompanied by severe hopelessness, is insufficient to precipitate an attempted suicide without the presence of the “acquired capability for suicide.” Because self-preservation is a powerful evolutionary imperative, executing lethal self-harm requires habituation to fear and physical pain. This acquired capability develops progressively through repeated exposures to painful and provocative events, such as historical trauma, chronic illness, combat exposure, self-injurious practices, and substance abuse.
Building upon Joiner’s model, the Integrated Motivational-Volitional (IMV) model proposed by Rory O’Connor and the Three-Step Theory (3ST) introduced by David Klonsky and Alexis May have further delineated the volitional phase of suicidal behavior. The IMV model posits that motivational triggers—such as feelings of defeat and humiliation—crystallize into entrapment, which is the perception that escape from painful internal and external states is impossible. Entrapment acts as the direct engine driving suicidal ideation. Transitioning from entrapment to an actual suicide attempt is governed by volitional moderators, which include access to lethal means, planning ability, impulsivity, imagery of death, and reduced physiological pain sensitivity.
7. Key Components, Types & Dimensions
Suicide attempts encompass diverse clinical behaviors that vary across multiple distinct dimensions:
- Level of Intent: Ranges from ambivalent attempts (where the individual leaves their survival to chance or initiates an act while actively wishing to be rescued) to absolute intent (where thorough measures are taken to guarantee death and prevent discovery).
- Objective Lethality versus Subjective Lethality: The divergence between the real medical potential for death based on physiological mechanism and the individual’s subjective cognitive expectation regarding how deadly that method would be.
- Impulsive versus Premeditated Attempts: Impulsive attempts are characterized by short latency periods between ideation and action, frequently catalyzed by acute intoxication or interpersonal rejection. Premeditated attempts involve meticulous planning, logistical preparation, and acquisition of highly specific instruments.
- Interrupted Suicide Attempt: Instances where an individual has actively initiated the behavioral sequence of an attempt, but an outside observer or external circumstance intervenes to halt the act before bodily harm occurs.
- Aborted Suicide Attempt: Situations where a person takes concrete steps toward an attempt, possessing lethal means in a prepared environment, but voluntarily ceases the process before inflicting self-injury.
- Re-Attempt (Chronic Suicidality): A behavioral pattern characterized by recurrent, multi-episode attempts, typical of individuals navigating severe personality disorders, refractory mood disorders, or extensive developmental trauma.
8. Examples & Illustrative Cases
The complex clinical dynamics of suicide attempts are clearly observed through structured clinical vignettes demonstrating contrasting presentations of intent, capability, and systemic risk factors.
Case Illustration 1: Acute Interpersonal Crisis and High Acquired Capability
A 34-year-old military veteran with a history of combat-related post-traumatic stress disorder and heavy episodic alcohol use experienced an acute, catastrophic marital separation. Following an escalation of alcohol consumption, the individual drafted a brief message to a sibling expressing severe perceived burdensomeness (“You will all be better off without me draining your resources”). He retrieved a firearm that he routinely kept loaded in his dwelling. Driven by profound entrapment and diminished fear of death developed through prior combat exposure, he placed the weapon to his temple. Seconds prior to pulling the trigger, law enforcement officers, dispatched by the alerted sibling, forced entry into the residence and physically tackled him to the floor. This event represents an interrupted suicide attempt featuring acute precipitating stressors, elevated acquired capability, access to lethal means, and intense, explicit suicidal intent.
Case Illustration 2: Ambivalent Intent with High Medical Morbidity
A 19-year-old university student with no past psychiatric contact experienced overwhelming academic failure accompanied by chronic social isolation. Enduring relentless, unarticulated psychache, the student consumed an entire bottle of concentrated acetaminophen from a local pharmacy, believing it would merely induce a lengthy, peaceful sleep during which their family would finally recognize their profound suffering. Thirty-six hours later, following severe nausea and abdominal pain, the student sought emergency medical attention. Despite experiencing moderate to low lethal intent, the somatic lethality was critically life-threatening, resulting in acute toxic hepatic necrosis requiring emergent N-acetylcysteine infusion and liver transplant evaluation. This case illustrates the perilous discordance between subjective intent and medical reality, underscoring that lower lethal intent does not preclude fatal somatic trajectories.
9. Measurement & Assessment
Accurate, empirical assessment of a suicide attempt and its associated future hazard requires validated clinical instruments and comprehensive forensic evaluation protocols. Unstructured clinical intuition alone is notoriously unreliable for estimating short-term and long-term suicidal risk; standardized assessment methodologies are mandatory in modern psychiatric and general hospital environments.
The current gold standard for classifying and tracking suicidal thinking and behavior is the Columbia-Suicide Severity Rating Scale (C-SSRS). Developed by Kelly Posner and colleagues, the C-SSRS systematically deconstructs suicidal behavior into distinct, mutually exclusive categories: passive ideation, active ideation with methods, active ideation with intent and plan, preparatory behaviors, aborted attempts, interrupted attempts, and actual suicide attempts. The scale also rigorously assesses the actual medical lethality alongside the patient’s perceived lethality for each documented event.
Complementing the C-SSRS, the Beck Scale for Suicide Ideation (BSS) and the Suicide Intent Scale (SIS), developed by Aaron Beck, are widely used psychometric tools. The SIS specifically reconstructs the circumstances of an attempt, evaluating both objective indicators (precautions against discovery, active preparation, presence of a suicide note) and subjective indicators (the patient’s stated purpose of the attempt, certainty regarding death, and feelings of regret or relief upon survival). Another prominent assessment framework is the Self-Injurious Thoughts and Behaviors Interview (SITBI), developed by Matthew Nock and colleagues, which demonstrates high inter-rater and test-retest reliability across adolescent and adult populations.
10. Applications & Practical Significance
The practical implications of understanding attempted suicide extend across emergency medicine, outpatient psychotherapy, public health policy, and environmental safety engineering. In acute medical settings, clinical teams must balance immediate physiological stabilization with compassionate psychiatric triage. Following somatic stabilization, the absolute priority is preventing imminent re-attempt through continuous monitoring and comprehensive safety planning.
A primary evidence-based clinical intervention is the Safety Planning Intervention (SPI), pioneered by Barbara Stanley and Gregory Brown. Rather than utilizing non-suicide contracts—which have repeatedly failed to demonstrate empirical efficacy—the SPI is a collaborative, brief intervention resulting in a prioritized list of coping strategies and resources. The plan covers six sequential steps: identifying internal warning signs; employing internal distraction strategies; contacting social contacts for distraction; reaching out to trusted friends or family members for crisis resolution; contacting mental health professionals and crisis centers; and systematically restricting immediate access to lethal means.
Lethal means restriction stands as one of the most effective suicide prevention measures across populations. Given that the latency between the decision to attempt suicide and the action itself is often extraordinarily brief—sometimes lasting fewer than ten minutes—introducing physical friction or temporal delays saves lives. Environmental applications include the installation of physical safety barriers on bridges and transit platforms, mandatory blister-packaging for analgesics, and safe storage counseling for personal firearms and lethal pharmaceuticals.
In outpatient psychotherapy, targeted modalities have demonstrated significant efficacy in reducing secondary suicide attempts. Dialectical Behavior Therapy (DBT), created by Marsha Linehan, is specifically structured to treat individuals with chronic suicidality, emotional dysregulation, and borderline personality disorder through mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness skills. Similarly, Cognitive Therapy for Suicide Prevention (CT-SP) focuses on identifying the cognitive pathways and “suicidal modes” that precede an attempt, teaching patients adaptive cognitive reframing and crisis-coping mechanisms to avoid recurrence.
11. Research & Empirical Evidence
Extensive epidemiological research indicates that a prior suicide attempt is the single most powerful clinical predictor of future suicide death. Longitudinal cohort investigations demonstrate that individuals presenting to emergency departments after a non-fatal attempt have an elevated risk of dying by suicide within the subsequent twelve to twenty-four months, with the risk remaining elevated for decades compared to matched community controls.
Neurobiological and genetic investigations have established that suicidal vulnerability possesses distinct biological correlates that partially decouple from standard psychiatric disorders. Post-mortem tissue analyses and neuroimaging studies led by researchers such as J. John Mann have identified significant alterations in the central serotonergic system. Specifically, blunted serotonergic responsiveness and abnormalities in serotonin 5-HT1A and 5-HT2A receptor binding in the ventral prefrontal cortex correlate with impaired behavioral inhibition, severe impulsivity, and elevated lethality of attempts.
Furthermore, dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis—evidenced by non-suppression on the dexamethasone suppression test and persistently elevated baseline cortisol—reflects profound, chronic stress system exhaustion among individuals who attempt suicide. Epigenetic investigations, including work on brain-derived neurotrophic factor (BDNF), demonstrate that early childhood physical abuse, neglect, and chronic adversity induce lasting alterations in neuroplasticity and emotional stress responses, lowering the biological threshold for future suicidal behavior.
12. Cultural & Cross-Cultural Considerations
The presentation, interpretation, and epidemiology of suicide attempts vary markedly across cultural contexts. While high-income Western countries typically report that women attempt suicide roughly two to three times more frequently than men (a phenomenon known as the “gender paradox in suicide,” where men die by suicide more often due to their selection of more violent, immediately lethal means), this pattern is not universally stable. In several rural low- and middle-income regions, particularly historically in parts of East and South Asia, the ratio of female suicide mortality and attempt lethality has approached or even exceeded that of males, frequently mediated by ready domestic access to highly toxic organophosphate agricultural pesticides.
Cultural, moral, and religious values deeply influence how an attempt is reported and socially addressed. In societies governed by stringent legal codes where attempted suicide remains criminalized—or where profound religious and familial taboos surround self-destruction—survivors and families often conceal attempts, reporting them to medical staff as accidental poisonings or domestic mishaps. This pervasive structural stigma discourages individuals from seeking post-crisis psychological care, thereby elevating the likelihood of recurrent attempts.
Among Indigenous communities globally, including First Nations, Native American, and Australian Aboriginal populations, rates of suicide attempts among adolescents and young adults are disproportionately high. Anthropologists and public health researchers attribute this to historical trauma, systemic dispossession, intergenerational cultural disruption, and systemic sociodemographic marginalization. Successful intervention in these contexts demands culturally integrated frameworks that incorporate tribal sovereignty, community connection, and the restoration of traditional cultural continuity rather than purely Western biomedical protocols.
13. Criticisms, Debates & Limitations
Despite substantial clinical advances, significant controversies persist within the discipline of suicidology. A major ongoing debate focuses on the limitations of statistical risk-prediction models. Decades of meta-analytic evidence, including extensive reviews by researchers such as Joseph Franklin and colleagues, have shown that standard clinical risk categorization (such as stratifying patients into “low,” “medium,” or “high” risk categories) possesses exceptionally poor positive predictive value. The vast majority of individuals categorized as “high risk” never attempt suicide, while a substantial number of actual attempts and suicide deaths occur among patients clinically categorized as “low risk.” Consequently, critics argue that psychiatric risk-stratification tools provide a false sense of security and can lead to unnecessary involuntary hospitalizations or, conversely, inadequate outpatient safety measures.
Another contentious issue involves the ethics and efficacy of involuntary psychiatric hospitalization following a suicide attempt. While civil commitment is intended to guarantee immediate somatic safety, critics argue that coercive containment, physical restraint, and institutionalization can exacerbate feelings of defeat, institutional betrayal, and entrapment. In fact, epidemiological research demonstrates that the period immediately following discharge from a psychiatric inpatient unit carries the highest statistical risk for completed suicide, highlighting potential gaps in post-discharge transition planning and therapeutic engagement.
Debate also surrounds the diagnostic classification of suicidal behavior in manuals such as the DSM-5. The introduction of “Suicidal Behavior Disorder” as a proposed independent diagnostic entity—distinct from mood, personality, or trauma disorders—remains contentious. Proponents argue that an independent diagnosis would validate suicide as an autonomous clinical target, driving focused research and targeted clinical interventions. Opponents caution that introducing an autonomous diagnostic code risks excessive pathologization, increases institutional stigma, and misattributes complex systemic, socioeconomic, and interpersonal crises entirely to individual psychological disease.
14. Related Terms & Distinctions
To prevent diagnostic confusion and ensure appropriate clinical care, an attempted suicide must be explicitly distinguished from related constructs:
- Non-Suicidal Self-Injury (NSSI): Deliberate, direct destruction of body tissue (e.g., cutting, burning, scratching) performed in the complete absence of suicidal intent. NSSI is typically utilized to regulate overwhelming negative affect, alleviate dissociation, or communicate distress, whereas a suicide attempt is driven by the desire to end life.
- Suicide Ideation: Cognitive contemplation, passive wishes, or active planning regarding self-destruction, but without the physical enactment of any preparatory or harmful behavioral sequence.
- Preparatory Suicidal Behaviors: Concrete acts undertaken in anticipation of an attempt, such as hoarding medication, acquiring a firearm, or writing a farewell letter, executed prior to any actual self-directed assault.
- Passive Death Wish: The generalized longing to cease existing or to pass away passively (e.g., “I wish I wouldn’t wake up tomorrow”), devoid of any active intent, plan, or self-injurious actions.
- Completed Suicide: A non-survived, fatal, self-directed act undertaken with the explicit or implicit intention of ending one’s life.
15. Summary / Key Takeaways
An attempted suicide is an acute behavioral emergency defined by self-directed, potentially injurious action paired with variable degrees of lethal intent. Understanding and preventing suicide attempts demands an integrative, multifaceted approach. While previous attempts stand as the single strongest clinical predictor of future suicide death, modern psychological frameworks—such as the Interpersonal Theory of Suicide and the Integrated Motivational-Volitional model—emphasize that the generation of suicidal ideation and the progression to physical action involve distinct psychological processes.
Effective prevention and clinical intervention rely on compassionate, standardized risk assessment, continuous therapeutic alliances, evidence-based psychotherapeutic paradigms such as Dialectical Behavior Therapy, collaborative Safety Planning Interventions, and decisive structural measures, particularly lethal means restriction. De-stigmatizing the experience of surviving a suicide attempt and expanding rapid, accessible, and community-centered crisis intervention remain among the most urgent imperatives in contemporary medicine and global public health.
References
- Beck, A. T., Kovacs, M., & Weissman, A. (1979). Assessment of suicidal intention: The Scale for Suicide Intent. Journal of Consulting and Clinical Psychology, 47(2), 343–352. https://doi.org/10.1037/0022-006X.47.2.343
- Franklin, J. C., Ribeiro, J. D., Fox, K. R., Bentley, K. H., Kleiman, E. M., Huang, X., Musacchio, K. M., Jaroszewski, A. C., Chang, B. P., & Nock, M. K. (2017). Risk factors for suicidal thoughts and behaviors: A meta-analysis of 50 years of research. Psychological Bulletin, 143(2), 187–232. https://doi.org/10.1037/bul0000084
- Joiner, T. E. (2005). Why people die by suicide. Harvard University Press.
- O’Connor, R. C., & Kirtley, O. J. (2018). The integrated motivational-volitional model of suicidal behaviour. Philosophical Transactions of the Royal Society B: Biological Sciences, 373(1754), 20170268. https://doi.org/10.1098/rstb.2017.0268
- Posner, K., Brown, G. K., Stanley, B., Brent, D. A., Yershova, K. V., Oquendo, M. A., Currier, G. W., Melvin, G. A., Greenhill, L., Shen, S., & Mann, J. J. (2011). The Columbia–Suicide Severity Rating Scale: Initial validity and internal consistency findings from three multisite studies with adolescents and adults. American Journal of Psychiatry, 168(12), 1266–1277. https://doi.org/10.1176/appi.ajp.2011.10111704