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Understanding adolescent responses to differently worded suicide attempt questions: results from a large US pediatric sample

Published online by Cambridge University Press:  02 December 2020

Claire Hatkevich*
Michigan Medicine, Ann Arbor, Michigan, USA
Jacqueline Grupp-Phelan
University of California San Francisco, San Francisco, California, USA
David Brent
University of Pittsburgh, Pittsburgh, Pennsylvania, USA
Bradley J. Barney
University of Utah School of Medicine, Salt Lake City, Utah, USA
T. Charles Casper
University of Utah School of Medicine, Salt Lake City, Utah, USA
Marlene Melzer-Lange
Medical College of Wisconsin, Milwaukee, Wisconsin, USA
Mary Cwik
Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
Cheryl A. King
Michigan Medicine, Ann Arbor, Michigan, USA
Author for correspondence: Claire Hatkevich, PhD, E-mail:



Clinical assessments are a primary method for ascertaining suicide risk, yet the language used across measures is inconsistent. The implications of these discrepancies for adolescent responding are unknown, which is troubling as multiple research areas (i.e. on culture, mental health language, and suicide communication) indicate individuals from varying sociodemographic backgrounds may communicate differently regarding mental health concerns. The aims of the current study are to investigate whether a geographically diverse sample of adolescents respond differently to directly and indirectly phrased suicide attempt questions (i.e. directly phrased includes the term ‘suicide’ and indirectly asks about suicidal behavior without using ‘suicide’), and to examine whether sociodemographic factors and history of mental health service usage relate to endorsement differences.


Participants were N = 5909 adolescents drawn from the Emergency Department Screening for Teens at Risk for Suicide multi-site study. The lifetime suicide attempt was assessed with two items from an adapted version of the Columbia Suicide Severity Rating Scale (C-SSRS; Posner et al., 2008): (1) a directly phrased question asking about ‘suicide attempts’ and (2) an indirectly phrased question providing the definition of an attempt.


An adolescent majority (83.7%) consistently reported no lifetime suicide attempt across items, 10.1% consistently reported one or more lifetime attempts across items, and 6.2% of adolescents responded discordantly to the items.


Multivariable models indicated multiple demographic and mental health service variables significantly predicted discordant responding, with a notable finding being that father/stepfather education level at or below high school education predicted endorsing only the direct question.

Original Article
Copyright © The Author(s), 2020. Published by Cambridge University Press

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