A 28-year-old female with bipolar I disorder is admitted to the psychiatric ward following a suicide attempt by self-harm. During the initial assessment, the clinician needs to obtain objective data on her current and past suicidal behaviour to inform her safety plan and length of stay. Which investigation is most appropriate for this structured documentation?

Explanation

## Suicide Assessment Instruments: Comparative Overview ### The Suicide Behaviors Questionnaire-Revised (SBQ-R) **Key Point:** The SBQ-R is a brief, validated self-report instrument that assesses lifetime suicide risk by measuring four dimensions: lifetime ideation and planning, frequency of ideation, communication of intent, and likelihood of future attempts. It is ideal for initial psychiatric intake and documentation. **High-Yield:** The SBQ-R is specifically designed to capture both past behaviour (attempts, ideation) and future risk in a single, concise instrument suitable for emergency and inpatient settings. ### Comparison of Suicide Assessment Tools | Instrument | Focus | Dimensions | Clinical Use | Timing | |---|---|---|---|---| | **SBQ-R** | Lifetime behaviour + future risk | 4 items (ideation, frequency, communication, likelihood) | Initial intake, risk stratification | Single administration | | **SSI** | Current ideation severity | 19 items (frequency, intensity, duration, control) | Ongoing monitoring, treatment response | Repeated assessments | | **Beck SIS** | Intent and planning | 20 items (circumstances, preparation, precautions) | Post-attempt evaluation | Single or repeated | | **HAM-D** | Depression severity | 17 items (mood, guilt, suicidality, etc.) | Depression monitoring, not suicide-specific | Repeated assessments | ### Why SBQ-R is Most Appropriate Here 1. **Comprehensive lifetime history:** Captures both past attempts and current risk in one instrument 2. **Brevity:** 4-item format suitable for acute psychiatric admission 3. **Predictive validity:** Strongly predicts future suicide attempts and is validated in inpatient populations 4. **Documentation:** Provides structured, quantifiable baseline for safety planning and discharge decisions **Clinical Pearl:** The SBQ-R score of ≥7 in females indicates high suicide risk and warrants close monitoring, frequent reassessment, and consideration of extended inpatient stay. **Mnemonic:** **SBQ-R = Screening + Behaviour + Questionnaire-Revised** — it screens for both past behaviour and future risk in a single tool. **Warning:** The HAM-D, while commonly used, is a depression severity scale, not a suicide risk instrument. It includes one item on suicidality but does not comprehensively assess suicide risk and should not be used as the primary suicide assessment tool.