Journal of Abnormal Child Psychology, Vol. 25, No. 6, 1997, pp.

465-473

Psychometric Properties and Clinical Utility of the

Scale for Suicide Ideation with Inpatient Children

Wesley D. Allan,1 Javad H. Kashani,1,2 Julie Dahlmeier,1 Payam Taghizadeh,1 and John
C. Reid1

Received January 15, 1997; revision received March 5, 1997; accepted April 15, 1997

The purpose of the current study was to examine the psychometric properties and clinical
utility of the Scale for Suicide Ideation (SSI) for children. The SSI was administered to 100
children who were hospitalized. Data were not used from 13 subjects due to the presence
of a psychotic disorder or IQ less than 70, leaving 87 participants. The SSI was examined
regarding its internal consistency, concurrent validity, construct validity, and factor structure
when used with children. Based on the findings, the SSI appears to have adequate psy-
chometric properties and can be used by clinicians and researchers examining children in
an inpatient setting. Recommendations for clinicians are included to help make the SSI more
functional in use for children.
KEY WORDS: SSI; suicide; assessment; children; validation.

There is increasing evidence that childhood sui-
cide, though still relatively rare in the general com-
munity (Asarnow & Carlson, 1988), does occur with
some regularity (Kelly, 1991; Sokol & Pfeffer, 1992).
Among children hospitalized on a psychiatric inpa-
tient unit, high rates (18% to 80%) of suicidal be-
havior, ranging from suicide ideation to actual
attempts, have been found (Milling, Campbell, Bush,
& Laughlin, 1992; Myers, Burke, & McCauley, 1985;
Pfeffer, Plutchik, Mizruchi, Faughnan, Mintz, &
Schindledecker, 1989). Similarly high rates (15% to
33%; Milling, Gyure, Davenport, & Bair, 1991; Pfef-
fer, Conte, Plutchik, & Jerret, 1980; Pfeffer,
Plutchick, Mizruchi, & Lipkins, 1986) of suicidal be-
havior have been found among outpatient children.
Further, there appears to be a dramatic rise in sui-
cidal behavior as children make the critical transition
from childhood to adolescence (Zubrick, Kosky, &
'University of Missouri—Columbia, Columbia, Missouri 65201.
2
Address all correspondence to Dr. Javad H. Kashani, Department
of Psychiatry and Neurology, University of Missouri—Columbia,
3 Hospital Drive, Columbia, Missouri 65201.
Silburn, 1987) and this trend continues through ado-
lescence and young adulthood. Regardless of preva-
lence rate, perhaps no other event has a more
profound and potentially damaging effect on a family
than when a child commits suicide (Gralnick, 1993).
The devastating impact such an event has on family,
friends, neighbors, and the community further dem-
onstrates that child suicide merits comprehensive re-
search and clinical attention.
As with any clinical phenomenon, assessment is
the commencement point in successful identification.
The primary purpose of assessment for suicidality is
"to be able to identify those at risk and to intervene
in a timely fashion" (p. 9; Eyman & Eyman, 1990).
Strictly speaking, prediction of suicidal behavior is
not possible due to the unpredictable nature of hu-
man behavior. Nevertheless, mental health profes-
sionals can measure one aspect of suicidal behavior,
suicide ideation, with some degree of certainty. Pfef-
fer (1989), who originally outlined the spectrum of
suicidal behaviors in children, defines suicide idea-
tion as having the wish to die. This definition was

465
0091-0627/97/1200-0465$ 12.50/0 © 1997 Plenum Publishing Corporation
466
elaborated upon by Steer, Rissmiller, Ranieri, and
Beck (1993), who indicated that suicide ideation is
"identified by the existence of current wishes and
plans to commit suicide" (p. 229). The relevance of
suicide ideation in adults has been demonstrated via
evidence that a relationship exists between the fre-
quency of suicide ideation and the likelihood of an
adolescent or young adult attempting to commit sui-
cide (Reynolds & Mazza, 1994; Schotte & Clum,
1982). Additionally, early identification of children
with suicide ideation can lead to the implementation
of treatment modalities aimed at suicide prevention
(Kashani, Goddard, & Reid, 1989).
Without adequate assessment measures for
measuring child suicidal behaviors, clinicians and re-
searchers cannot sufficiently address the burgeoning
problem of child suicide. Although there are a few
well-validated measures that have been designed to
measure adult suicide ideation, even fewer have been
devised specifically for an adolescent population (Ey-
man, Mikawa, & Eyman, 1990). Further, to our
knowledge, no measure has been specifically devised
to assess child suicide ideation. A few self-report
measures have been developed for use with adoles-
cent suicidal behavior (e.g., Suicidal Ideation Ques-
tionnaire; Reynolds, 1988). However, it is
questionable if children can adequately understand
a questionnaire measuring suicide ideation, which is
a complex construct, and provide an accurate de-
scription of their thoughts, feelings, and behavior. An
interview, clinician-rating method, therefore, may be
preferable to ensure that the child understands the
questions and to probe for relevant information.
One well-validated clinician rating scale that has
been used with adults and adolescents to measure
suicide ideation is the Scale for Suicide Ideation
(SSI; Beck, Kovacs, & Weissman, 1979). The SSI has
been validated for assessing the presence, degree,
and dimensions of suicide ideation for adults (Beck
et al., 1979). Steer, Kumar, and Beck (1993) admin-
istered the BSI (i.e., the self-report version of the
SSI) to 108 inpatient adolescents and documented
that the scale was useful in assessing adolescent sui-
cide ideation. Despite these promising findings, to
date, the psychometric properties of the SSI have not
been examined in relation to children. Given the suc-
cess in using the SSI with adolescents and the lack
of validated evaluation procedures in measuring sui-
cide ideation in children, the SSI appears to be a
promising tool to fill this assessment gap. The pur-
pose of the present study, therefore, was to examine
Allan, Kashani, Dahlmeier, Taghizadeh, and Reid
the psychometric properties and clinical utility of the
SSI for children who have been psychiatrically hos-
pitalized.
METHOD
Participants
One hundred children (ages 7 to 12 years old)
drawn from consecutive admissions to a children's in-
patient unit of a university-based mental health cen-
ter in a midsized Midwest city participated in the
study. Thirteen children were excluded because they
either had a full-scale I.Q. of less than 70 points or
were diagnosed by the treatment team as having a
psychotic disorder, leaving a total of 87 participants.
This sample consisted of 65 males and 22 females.
In terms of race, 82 of the children were Caucasian
and five were African-American, which is repre-
sentative of the town in which the study was con-
ducted. Utilizing a 5-point scale of parental annual
income (1 = $30,000 and above; 2 = $25,000 to
$29,999; 3 = $15,000 to 24,999; 4 = $9,000 to
$14,999; 5 = below $9,000), the modal reported so-
cioeconomic status (SES) was 5 (n = 26), with SES
levels 4 (n = 25) and 3 (n = 23) accounting for the
majority of the remainder of the sample. Few par-
ticipants were included in the higher SES categories
(n = 5). SES data were unavailable for eight partici-
pants.
Instruments
The Scale for Suicide Ideation. The Scale for Sui-
cide Ideation (Beck et al., 1979) was developed to
quantify and assess the degree of suicide ideation in
adults. The scale is a clinician-rating scale and is pre-
sented in a semistructured, interview format (Schotte
& Clum, 1982). After the interview, the clinician as-
sesses 19 items that evaluate three dimensions of sui-
cide ideation: active suicidal desire, specific plans for
suicide, and passive suicidal desire (Beck et al.,
1979). Each item is rated on a 3-point scale (i.e., 0
to 2). The total score is computed by adding each
item score. The range of possible scores is 0 to 38,
with higher scores indicating greater presence of sui-
cide ideation.
The psychometric properties of the SSI were
evaluated by Beck et al. (1979) on a sample of 90
Psychometric Properties of SSI with Children
adults who were psychiatrically hospitalized. The in-
ternal consistency of the scale was good (a = .89).
However, three items (Items 13, 18, and 19) showed
poor item-total score correlations. Additionally, all
subjects in the sample had a zero coding on item 17
(i.e., "suicide note"), indicating that no subject
thought about or completed a suicide note while ex-
periencing suicide ideation.
The Diagnostic Interview for Children and Ado-
lescents (DICA). The DICA was developed by Her-
janic and Reich (1982) and is a diagnostic
interview based on Diagnostic and Statistical Man-
ual of Mental Disorders (DSM3-R; APA, 1987)
criteria that is administered to a child or adoles-
cent. Various internalizing and externalizing diag-
noses (e.g., major depressive disorder, separation
anxiety disorder, conduct disorder, oppositional
defiant disorder) are included and good reliability,
validity, and parent-child agreement have been
found (Welner, Reich, Herjanic, Jung, & Amado,
1987).
The Hopelessness Scale for Children. The Hope-
lessness Scale for Children was developed by
Kazdin, French, Unis, Esveldt-Dawson, and Sherick
(1983) and was modeled after the adult Hopeless-
ness Scale (Beck, Weissman, Lester, & Trexler,
1974). The scale was designed to measure hopeless-
ness, or negative expectation toward the future, in
children. It is a 17-item, true-false, self-report meas-
ure that has shown good psychometric properties
(Kazdin et al., 1983; Kazdin, Rodgers, & Colbus,
1986).
The Children's Depression Rating Scale
(CDRS). The Children's Depression Rating Scale
was developed by Poznanski, Cook, and Carroll
(1979) to measure the degree of depressive symp-
tomatology in children and adolescents. This 17-
item clinician-rating scale has documented good
reliability and validity (Poznanski et al., 1984) as
well as clinical utility (Poznanski, Cook, Carroll, &
Corzo, 1983).
The Child Behavior Checklist (CBCL). The Child
Behavior Checklist was developed by Achenbach
(1978) as a broad-band measure of a child's exter-
nalizing and internalizing behaviors, as reported by
a parent or other caretaker. The 113 items are rated
on a 0 (not true) to 2 (very true or often true) scale.
Good reliability and validity has been found for the
scale (Achenbach, 1978).
467
Procedure
After a description of the unit was supplied to
parents, written informed consent was obtained for
each child to participate in assessment, treatment,
and research. The DICA and Hopelessness Scale
were administered to each child by a doctoral student
in clinical psychology as part of a basic assessment
on the inpatient unit that occurs within the first week
of the child's hospitalization. The CDRS was then
completed by the research assistant following the ad-
ministration of the DICA. The CBCL was adminis-
tered by the same research assistant to a parent or
caretaker of each child, generally the mother. The
Scale for Suicide Ideation was completed by a mem-
ber of the inpatient psychiatric nursing staff following
an interview with the child. Finally, after a compre-
hensive evaluation, a discharge diagnosis for each
child was made by a child psychiatrist who received
input from members of a treatment team during a
meeting subsequent to the child's admission.
RESULTS
Eighteen children (21%) displayed suicide idea-
tion as defined by Beck, Steer, and Brown (1993).
That is, either question 4 (i.e., "Desire to make active
suicide attempt") or Question 5 (i.e., "Passive suici-
dal desire") was positively endorsed for these chil-
dren. Among these 18 children, most exhibited low
to moderate levels of suicide ideation (range of SSI
total scores = 2 to 16). The mean for the children
with suicide ideation was 7.72 (SD = 3.43), which is
comparable to the mean of 5.85 (SD = 8.36) found
for adolescents with suicide ideation (Steer, Kumar,
& Beck, 1993). Additional analyses were computed
to assess the psychometric properties of the SSI.
Reliability
Internal Consistency. The internal consistency of
the SSI was evaluated by two methods. First, item-
total correlations were calculated and ranged from r
= .30 to r = .76 (see Table I). Further, 17 of the 19
correlations were significant. The second method
used for examining internal consistency was the cal-
culation of coefficient alpha (a = .88).
468 Allan, Kashani, Dahlmeier, Taghizadeh, and Reid

Table I. Item-Total Score Correlations for the Scale

for Suicide Ideation Items
Pearson correlation
Item" coefficient
SSI 1 .30*
SSI 2 .76"
SSI 3 .45°
SSI 4 .69C
SSI 5 Alc
SSI 6 .66C
SSI 7 .58C
SSI 8 .32C
SSI 9 .32*
SSI 10 .58C
SSI 11 .72C
SSI 12 .6<f
SSI 13 .6QF
SSI 14 .73°
SSI 15 .49e
SSI 16 .32*
SSI 17 -
SSI 18 -
SSI 19 .346
"SSI = Scale for Suicide Ideation.
bp < .005.
cp < .0001.

Validity Additionally, Items 18 and 91 on the CBCL were

Concurrent Validity. Concurrent validity of the
SSI was examined by determining the degree to
which the scale correlated with other markers of sui-
cidal ideation. Given that the SSI was completed by
a member of the nursing staff, we wanted to compare
it to measures completed by other sources, including
another staff member (the CDRS completed by the
research assistant), the child (DICA), and a parent
(CBCL). Specifically, SSI total scores were compared
to the self-harm items of the CDRS: Items 12 ("mor-
bid ideation") and 13 ("suicide and suicide idea-
tion"). Total scores on the SSI for the sample were
significantly correlated with CDRS Item 12 (r = .63;
p = .001) and Item 13 (r = .63; p = .001).
For the DICA, children who endorsed thinking
about death in general (n = 17) scored significantly
higher (t = -3.42, p = .003) on the SSI (mean =
4.71, SD = 4,2) than children who did not endorse
that statement (n = 68; Mean = 1.1, SD = 2.5).
Similarly, on the DICA, children who endorsed
thinking about their own death (n = 21) scored
higher (t = -2.86, p = .009) on the SSI (mean =
3.90, SD = 4.3) than children who did not endorse
this statement (n = 64; mean = 1.11, SD = 2.44).
examined. Children who received a positive response
(i.e., a score of 1 or 2) on Item 18 ("Deliberately
harms self or attempts suicide") were compared on
SSI total scores to children who received a "zero" re-
sponse on item 18. A Mest revealed no difference be-
tween these groups (t = -0.93, p = .36). In contrast,
children who received a positive response on Item 91
("Talks about killing self") scored significantly higher
on the SSI total score than children who received a
zero response (t = -2.15, p = .03).
Construct Validity. To evaluate construct validity,
hypotheses from Beck and colleagues (Beck et al.,
1979) were extrapolated to our sample. Specifically,
it was expected that suicide ideation would be more
closely related to hopelessness than to depression
(Beck, 1986). Both hopelessness and depression were
correlated with suicide ideation scores (r = .39, p =
.0002; r = .55, p = .0001, respectively). The relation-
ship between hopelessness and suicide ideation re-
mained significant (r = .29, p = .006) when
controlling for depression scores. Likewise, the rela-
tionship between suicide ideation and depression was
still significant (r = .50, p = .0001) when controlling
for hopelessness scores. Because the relationship be-
tween suicide ideation and depression was as strong
as the relationship between suicide ideation and
Psychometric Properties of SSI with Children 469

Table II. Varimax Rotated Principal-Components Analysis of the Scale for Suicide Ideation
Loading
Factor I Factor II
Factor I
1. Wish to die .769 .149
4. Desire to make active suicide attempt .824 .124
7. Time dimension: Frequency .781 .285
8. Attitude toward ideation/wish .667 .362
11. Reason for contemplated attempt .527 .096
Eigenvalue = 6.45 Variance explained = 3.19
Factor II
3. Reason for living/dying .138 .479
5. Passive suicidal desire .069 .739
6. Time dimension: Duration .332 .620
10. Deterrents to active attempt .191 .752
14. Sense of capability to carry out .223 .531
15. Expectancy/anticipation of event .532 .622
Eigenvalue = 2.55 Variance explained = 2.75
Miscellaneous items
1. Wish to live .003 -.126
12. Method: Specificity/planning .209 .240
13. Method: Availability/opportunity .164 .077
16. Actual preparation .043 .115
19. Deception/concealment of suicide .093 -.090
Deleted items
_ _
9. Control over suicidal action _
17. Suicide note _
18. Final acts - -

hopelessness, our original hypothesis was not sup-
ported.
It was also anticipated (Kosky, Silburn, &
Zubrick, 1986; Steer, Kumar, & Beck, 1993) that
children who received discharge diagnoses of major
depressive disorder or dysthymia would score higher
than children who were diagnosed with another,
nonaffective, disorder (e.g., attention deficit hyperac-
tivity disorder, conduct disorder). This hypothesis
was upheld (t = -5.88, p = .0001) and children with
an affective disorder (n = 13) received higher SSI
scores (mean = 6.46, 5D = 3.2) than children with
another disorder (n = 72; Mean = 0.97, SD = 2.4).
Factor Analysis. As indicated previously, Beck
and colleagues (1979) found three dimensions of sui-
cide ideation (i.e., active suicidal desire, specific
plans for suicide, and passive suicidal desire). The
data from our sample on the SSI were subjected to
a factor analysis (see Table II). A principal-compo-
nents analysis with varimax rotation was conducted
and items were retained on a factor if r > .30. Three
Items (i.e., items 9, 17, and 18) received zero totals
for the entire sample and were thus deleted prior to
conducting the factor analysis to avoid problems with
noncollinearity.
Initial results indicated that four factors ex-
isted; however, some of these factors were com-
prised of few items. Maintaining factors only if
they included at least four items and received an
eigenvalue >1.0 revealed that two factors existed
with five miscellaneous items. Factor I (eigenvalue
= 6.45; variance explained = 3.19) was comprised
of Items 2, 4, 7, 8, and 11, which constitute "active
suicidal desire" (Beck et al., 1979). Factor II
(eigenvalue = 2.55; variance explained = 2.75)
consisted of Items 3, 5, 6, 10, 14, and 15, which
were a mixture of "active suicidal desire" items and
"passive suicidal desire" items (Beck et al., 1979).
It should be noted, however, that we used more
stringent criteria than Beck et al., (1979), who
maintained a factor (i.e., Factor III) that consisted
of only three items.
470
DISCUSSION
The purpose of the current study was to examine
the use of the Scale for Suicide Ideation with chil-
dren who are psychiatrically hospitalized. The use of
multiple measures (i.e., the DICA, CDRS, Hopeless-
ness Scale) and multi-informants (i.e., parent, child,
staff members) allowed for a thorough evaluation of
the SSI. The results demonstrate that the scale is a
reliable and valid measure of suicide ideation in this
population. As assessed by the scale, 18 children
(21%) displayed significant levels of suicide ideation
and would be classified as actively experiencing sui-
cide ideation. This rate is consistent with the fre-
quency found using other measures of suicide
ideation (cf. Milling et ah, 1991), adding credence to
the assertion that the SSI adequately measures sui-
cide ideation in children.
Good internal consistency and concurrent valid-
ity were illustrated for the scale. In terms of internal
consistency, the scale appears to hang together well
and compares favorably to the results of Beck et ah
(1979) using adult data. Additionally, data from the
SSI, which was completed by a member of the nurs-
ing staff, were consistent with information collected
from the child (DICA items), the parent (CBCL
Item 91), and another staff member (CDRS items).
It should be noted that children who scored high on
Item 18 on the CBCL ("Deliberately harms self or
attempts suicide") did not score higher on the SSI
than children who received a zero response for that
item. However, many of the parents who endorsed
this item circled the "harms self" component, which
could conceivably include nonsuicidal behaviors, in-
cluding self-injurious and risk-taking behaviors.
In documenting the construct validity of the
scale, children with depression scored higher on the
SSI than children with other, mostly externalizing
disorders, helping to document that the scale meas-
ures what it purports to measure. However, one hy-
pothesis that was not upheld was that hopelessness
scores would be more highly related than depression
scores to children's SSI scores (Beck et ah, 1979).
This hypothesis was based on previous research in-
dicating that hopelessness is generally more predic-
tive than depression of level of suicide ideation in
adults (e.g., Beck, Steer, Beck, & Newman, 1993)
and children and adolescents (Kashani, Reid, &
Rosenberg, 1989). However, this finding has not been
found universally in child samples, with some studies
(e.g., Marciano & Kazdin, 1994) finding that child-
Allan, Kashani, Dahlmeier, Taghizadeh, and Reid
hood depression is the best predictor of suicide idea-
tion. Further, a high degree of hopelessness was
found in our current sample and the limited variabil-
ity in hopelessness scores may have made it difficult
to contrast level of hopelessness to another construct
such as suicide ideation.
One of the purposes of the present study was
to determine the underlying dimensions of suicide
ideation for children who have been hospitalized and
ascertain whether these factors are similar to those
derived for adults by Beck et ah (1979). The results
displayed that, for inpatient children, the SSI consists
of two factors with five miscellaneous items. Addi-
tionally, three items could not be used in the factor
analysis because they were not endorsed for any of
the children (i.e., "Control over suicidal action", "sui-
cide note", "final acts"). Thus, when used with chil-
dren, we did not find the same three-factor pattern
that has been found for adults (e.g., Beck et ah,
1979). This finding is not surprising considering that
Holden, Mendonca, and Mazmanian (1985) failed to
replicate the three-factor structure with adults. Thus,
researchers and clinicians may find it more useful to
forgo deriving factor scores for children, but instead
examine total scores and individual items of the
scale.
Beck et ah, (1979), in their original validation
of the scale for adults, found that several items had
low item-total correlations and did not contribute to
the factor structure of the scale. However, the
authors contended that these items should be re-
tained due to their prognostic value as notable clini-
cal demonstrations of the severity of suicide ideation.
This statement seems to apply well to our data and
argues for the retention of all items of the SSI, even
though some of them seemingly dilute the factor
structure and result in a less unified scale. Thus, al-
though we did not find a strong factor structure for
the scale and some of the items were not particularly
relevant for the sample due to the low frequency of
some behaviors in our child sample (e.g., writing a
suicide note), the findings indicate that the SSI is a
reliable and valid measure when used with children
who are hospitalized.
As we indicated, some behaviors included on the
SSI apparently occur at such low frequencies that,
even among a relatively large sample of children with
prominent suicide ideation, they were not reported.
Although these behaviors seem rare, they are clini-
cally meaningful in that their presence may greatly
aid clinicians in predicting potential child suicides.
Psychometric Properties of SSI with Children
Consequently, it is recommended that these items re-
main on the scale and be used by clinicians and re-
searchers working with children. Item 18 may be
more useful if it is altered slightly. On the adult form,
"Final acts" includes examples, such as getting life
insurance and writing a will, that are highly unlikely
to be undertaken by children. Including "final acts"
such as giving away prized possessions or saying
goodbye to friends may increase the clinical utility of
this item for children.
Limitations
Some limitations of the current study must be
discussed. First, the study used exclusively children
who were hospitalized in a psychiatric inpatient unit.
Although this sample was limited in nature, this popu-
lation is the most likely one to exhibit notable suicidal
behaviors, such as suicide ideation (Milling et al.,
1991). Second, the sample was composed dispropor-
tionately of males and Caucasians. Third, the SSI was
designed for use with adults. However, it is not un-
common for adult measures to be extended for use
with children and adolescents. For example, the Beck
Depression Inventory (Beck, Ward, Mendelson,
Mock, & Erbaugh, 1961) was clearly designed for use
with adults, but has been validated for use with ado-
lescents (cf. Kashani, Sherman, Parker, & Reid, 1990).
Fourth, the SSI was completed by one interviewer per
child and interrater reliability could therefore not be
computed. Overall, the present study provides data
indicating that, for clinicians or researchers, the use
of the SSI with children appears to be part of a useful
assessment package for suicidal behaviors.
Clinical Implications
Suicide crisis intervention with youngsters typi-
cally involves six steps: (1) engagement and rapport
building, (2) identification of suicide potential, (3) as-
sessment of details of the child's life, (4) risk assess-
ment, (5) action agreements, and (6) implementing
an intervention plan (Tierney, Ramsay, Tanney, &
Lang, 1990). In this model, a well-validated measure
of suicide ideation may provide significant clinical
utility during the risk assessment component of sui-
cide appraisal.
Based on the current psychometric findings, the
SSI can be utilized to provide a framework for risk
assessment by clinicians who are working with suici-
471
dal or troubled children. One particular benefit of
the SSI is its flexibility, with both clinician-rating and
self-report scales available. The scale provides an in-
depth evaluation of the content and degree of the
child's suicide ideation. Such critical information as
whether the child has a specific plan, whether the
plan is lethal, and whether the child is intent on car-
rying out the plan can be elicited. Additionally, the
scale may be used at the time of admission or be-
ginning of therapy and at the time of discharge or
termination to provide the clinician with useful in-
formation regarding treatment efficacy and degree of
change in the child (such data were not collected in
this study).
Future Research
The influence of "suicide contagion" is often no-
table in children (e.g., Gould & Shaffer, 1986; Gould,
Wallenstein, & Davidson, 1989; Pfeffer, 1989; Rob-
bins & Conroy, 1983) and the inclusion on future
versions of the SSI of a child's exposure may be
beneficial. Youngsters are uniquely affected by expo-
sure to the suicidal behaviors of other people, which
may serve to prompt child suicides (Pfeffer, 1989).
This exposure can occur through the media (e.g.,
television, newspapers, local news; Gould & Shaffer,
1986), personal experience (suicidal friends, family
members, neighbors), or even reading about the sui-
cides of fictional characters (Pfeffer, 1990). The man-
ner in which this exposure may influence suicide
ideation may be useful in prediction of eventual sui-
cide and perhaps should be incorporated into future
versions of the SSI.
Additional examination of the SSI in a nonhos-
pitalized population of children may be helpful in de-
termining whether the scale can be used with children
being treated as outpatients basis. Further, the self-
report version of the Scale for Suicide Ideation (the
BSI), should also be examined in terms of applicabil-
ity for children. One of our main tenets of using the
clinician-rating scale version was an assumption that
children would have a difficult time completing the
self-report version due to their level of cognitive de-
velopment. However, a self-report version may have
obvious benefits, including easy administration for
epidemiological studies and perhaps a more un-
equivocal and direct measure of the phenomenology
of suicide ideation experienced by children.
472
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