Objective
Globally, more than 700,000 people die by suicide every year, which has become a public health concern worldwide (WHO, 2021). More than 15% of children and adolescents reported suicidal ideation in China (Tan et al., 2018; Zhang et al., 2018). Early screening for suicide risk is critical to prevent suicidal thoughts from transform into suicidal behavior. The current approach to suicide risk screening mainly relies on self-report methods. However, these tools have many limitations, such as social desirability (Franklin et al., 2017). Based on the spreading-activation model (De Wit & Kinoshita, 2015), this study developed an implicit Suicide Stem Completion measurement (SSCM)- Chinese version, and explored the validity of this tool in a large sample of Chinese adolescent population.
Methods
Firstly, the team of experts screened the suicidal words and neutral words, and completed the compilation of the SSCM after discussion and evaluation. Second, verify SSCM’s reliability and validity. A total of 2,250 students (1,259 males, 15.14 ± 1.60 years) from two middle schools in Zhejiang Province were recruited to complete the SSCM, Suicidal Behaviors Questionnaire, the Suicidal Attitude Scale, the Patient Health Questionnaire-9, the Deliberate Self-Harm Inventory and the Positive Psychological Capital Questionnaire. Then, SPSS and Amos were used for data analysis factor analysis. Cronbach's α, Statistical hypothesis testing, Pearson correlation and Receiver Operating Characteristic (ROC) curve analysis were used to verify the structure, reliability and validity of the SSCM and the predictive effect of suicide risk.
Results & Discussion
Result：(1) The one-dimensional structure of the SSCM has a good fit (χ² = 113.08, df = 9, p < .001, CFI = .96, NFI = .95, IFI = .96, TLI = .93, SRMR = .07, RMSEA = .07). (2) The Cronbach's α and split-half reliability coefficients of the scale is respectively .74、.70. (3)There is a significant correlation between SSCM and criterion (r = -0.26 ～ -0.37; 0.27 ～ 0.46, p_s < 0.001). (4) The ROC curve analysis showed the risk assessment was scored as a cut-off point of 1 and its diagnostic accuracy is 76%.
Discussion: The one-dimensional structure of SSCM was strongly validated by exploratory and confirmatory factor analysis. The reliability and validity of this questionnaire were supported from multiple perspectives, including emotional and positive psychological perspectives. This questionnaire has significant diagnostic value for whether the risk of suicide is serious. In addition, this study can support the theoretical mechanism of spreading-activation model.
Conclusions
We have developed a localized tool for measuring suicide risk from an implicit perspective – SSCM. It exhibits good psychometric properties and can be used as a psychological crisis or suicide risk measurement tool to comprehensively screen for suicide risk.
Acknowledgement: This research was supported by the Zhejiang Educational Science Planning Project (No.2024SCG358), Zhejiang Province Philosophy and Social Science Planning Project (No.24NDQN22Z).
References:
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.
WHO. (2021). World health statistics 2021: monitoring health for the SDGs, sustainable development goals (https://iris.who.int/handle/10665/342703). World Health Organization.
 

suicide risk measurement; Implicit; reliability; validity