Development of a tool for assessing awareness of consequences of suicide

Vanessa Gail Macintyre^1,2*Daniel Pratt^1,2,3*Warren Mansell^1,2,4Sara Jane Tai^1,2*

• ¹The University of Manchester Division of Psychology and Mental Health, Manchester, United Kingdom
• ²Manchester Academic Health Science Centre, MAHSC, Manchester, United Kingdom
• ³Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
• ⁴Curtin enAble Institute, Curtin School of Population Health, Curtin University, Perth, Australia

Objectives: The ways in which individuals consider the potential impact of suicide on their life goals (i.e. consequences of suicide) may influence their suicidal ideation and/or behavior, but no measures exist for assessing awareness of consequences of suicide. A new measure is needed to ensure reliable and valid measurement which then enables accurate testing of hypotheses regarding consequences of suicide. The current study aimed to develop and refine a new tool for assessing awareness of potential consequences of suicide (Awareness Assessment Tool; AAT). Design: Multiple stages of AAT development involved analysis of qualitative data from two sets of interviews. Methods: Interviews with 12 participants who had contemplated or attempted suicide were analyzed using Reflexive Thematic Analysis (TA) to evaluate potential AAT items (Stage 1), followed by initial item development (Stage 2). Cognitive interviews to evaluate the AAT were then conducted with nine individuals with experience of suicidal ideation and/or behavior and analyzed using TA (Stage 3), followed by further AAT refinement (Stage 4). Results: The following themes were identified at Stage 1: "The interview as an acceptable and helpful experience" and "The relationship between one's mindset and ability to remember experiences of suicide". Stage 3 analysis generated the following themes: "Limitations of the AAT design"; "The AAT as an acceptable measure of a potentially helpful idea"; "The importance of accounting for failure to reach goals"; "Psychological processes regarding the potential impact of suicide captured by the AAT"; "The importance of assessing short-term goals". In Stage 4, the phrasing and length of AAT items were refined, some items were added, and improvements were made to the interviewer instructions and prompts in the AAT. Conclusion: Patterns of responding to AAT items were highlighted and refinements were made to improve the AAT. Overall, the AAT was experienced as acceptable and sometimes helpful, with demonstrable potential for use in future research.