374 Personality and Social Psychology(4) Measurement Issues in Studies Examining would constitute the only impulsive action because this ness of Specific Suicide Attempts oehavior had not been planned an ironic possibility indi ngthat "whim The inconsistent operationalizations of impulsive attempts indicate a potential problem in the measurement of the co d high-letal ts lar t their decision an we tu our attention nich th scale of Beck's Suicide Intent Scale (SIS:Beck 1990:Beck ep sense of regret regar Schuvler.Herman.1974)is the most commonly used mea .they fela de sure for the their decision or contacting help (Bourke,Shapiro,Steel,& ever,th .ha fson,2006). item from the measure,other permutations utilized includ Other items included in var ub note, 3-,7-,and 8-item versions (e.g.,Brown et al. 1991 l et a cated to others about their desire to attempt suicide.Each of hle2 for a all studie with respect to the me urement o 8-item versions of the SIS utilize the same items(e.g.,Baca resp Garcia et al.,2005;Ma Malone 1997).To our know 20051A studi g hat a lack of a note indicates impulsivity is problemati f al h dds of an a port.Indeed,the lack of other established mea ures of thi p by ts a sigr nt obstacle in suicide re ive the iten tcomings SIS Sh. n the impu itself focuses purely on interpersonal actions(e.g. making selection The content of hanges to w rel ome of the items calls into ques tion the validity of th re in the assessment of the mpu hich ind ng th Furthermore.the item overlooks the fact that individuals the SIS Plan mpting suicide feel isolatec fron ers and may subscale with less lation conceptualized as indicating eater This item seems problen becaus ed burd ntaisa belief thatthe nal' ng from death will be worth more than his or her life,implying a a particular public ce (e.g. er,2 5 the Golden Gate Bridge)offers the greatest chance at death and nsively to tilize at loc hought with another r n reflects the degree to which tha Another item utilized in various forms of the Planning ong-term atl on the worl subscale of the SIS ses sthe degree to which an individ indicate and thu mp m vould cont radict the notion of an impulsive attempt ualized as indicating Tellingly,Robins(1981)found that 70%of suicide dece Here again.the relevance of this item to the impulsivity of in the daysbefor n an n argumen Perhat s the most important limitation to the items in the various forms of the Planning subscale of the SIS is the item hat most directly overlaps with othe measure used death In other words if an individual the attempt,enacts the planned method,but feels rush of fear y,one item a during or immediately after this process (an or to the attempt.with the available answers being"impul life-sa the atte sive;no premeditation,""considered for<hr,""considered sive.Instead,the person's efforts to preserve his or her life consider day. 374 Personality and Social Psychology Review 18(4) Measurement Issues in Studies Examining Impulsiveness of Specific Suicide Attempts The inconsistent operationalizations of impulsive attempts indicate a potential problem in the measurement of the con￾struct. Therefore, we turn our attention to ways in which the impulsiveness of attempts is measured. The Planning sub￾scale of Beck’s Suicide Intent Scale (SIS; Beck, 1990; Beck, Schuyler, & Herman, 1974) is the most commonly used mea￾sure for the assessment of impulsiveness of attempts; how￾ever, there is little consistency in the number and selection of items to be used. Whereas some work has used only a single item from the measure, other permutations utilized include 2-, 3-, 7-, and 8-item versions (e.g., Brown et al., 1991; O’Donnell et al., 1996; Verkes et al., 1998; Weyrauch, Roy￾Byrne, Katon, & Wilson, 2001; Wong & Phillips, 2009; see Table 2 for a summary). Furthermore, not all studies using 8-item versions of the SIS utilize the same items (e.g., Baca￾Garcia et al., 2005; Mann & Malone, 1997). To our knowl￾edge, no studies have been conducted comparing scores on this measure of planning to other such measures, thereby leaving the validity of the subscale without empirical sup￾port. Indeed, the lack of other established measures of this construct represents a significant obstacle in suicide research. The shortcomings of the SIS in the assessment of impul￾sivity of attempts are not limited to inconsistency in item selection. The content of some of the items calls into ques￾tion the validity of the measure in the assessment of the impulsivity of attempts. For instance, an item assessing the degree to which individuals who attempt suicide do so in isolation from others is often included in the SIS Planning subscale, with less isolation conceptualized as indicating greater impulsivity. This item seems problematic because many highly lethal methods (e.g., jumping from high places) often involve attempting suicide near other people and, if an individual decides that a particular public space (e.g., the Golden Gate Bridge) offers the greatest chance at death and plans extensively to utilize that location, the public nature of the event does not seem relevant to the planning that went into the action itself. Another item utilized in various forms of the Planning subscale of the SIS assesses the degree to which an individ￾ual who attempts suicide makes an effort to get help during or after the attempt, with greater help-seeking behavior con￾ceptualized as indicating greater impulsiveness of attempt. Here again, the relevance of this item to the impulsivity of the attempt is unclear. In fact, an argument could be made that, in this scenario, the only impulsive activity is the effort to contact others and preserve life in the face of imminent death. In other words, if an individual thoroughly plans an attempt, enacts the planned method, but feels a rush of fear during or immediately after this process (and this sequence of events does occur regularly), prompting an effort to obtain life-saving assistance, the attempt itself would not be impul￾sive. Instead, the person’s efforts to preserve his or her life would constitute the only impulsive action because this behavior had not been planned—an ironic possibility indi￾cating that “whims to live” may exist whereas “whims to die” do not. The possibility that individuals who make well￾planned high-lethality attempts lament their decision and “flinch” is supported by the stories of survivors who jump from the Golden Gate Bridge, who have reported that imme￾diately after jumping, they felt a deep sense of regret regard￾ing their actions but were obviously incapable of reversing their decision or contacting help (Bourke, Shapiro, Steel, & Wolfson, 2006). Other items included in various forms of the Planning subscale assess whether individuals left a suicide note, took specific actions in anticipation of their death, or communi￾cated to others about their desire to attempt suicide. Each of these items has significant problems with respect to the mea￾surement of impulsivity as well. With respect to suicide notes, research has indicated that only 20% to 35% of suicide decedents leave notes (e.g., Shioiri et al., 2005). Assuming that a lack of a note indicates impulsivity is problematic because it increases the odds of an attempt being considered impulsive by requiring that a relatively rare behavior (note￾leaving) occur for an attempt to be considered non-impul￾sive. With respect to taking preparatory actions, the item itself focuses purely on interpersonal actions (e.g., making changes to will, taking out insurance) that may not be rele￾vant to some individuals (e.g., individuals without a will or the assets or the legal representation needed to develop one). Furthermore, the item overlooks the fact that individuals attempting suicide typically feel isolated from others and thus may be disinclined to take actions directly related to other people’s well-being (although the construct of per￾ceived burdensomeness entails a belief that the individual’s death will be worth more than his or her life, implying an effort to help others through lethal self-harm; Joiner, 2005). With respect to overt communication, it is simply unclear conceptually how an individual’s decision to discuss a thought with another person reflects the degree to which that thought has been developed over time and considered within the context of its short- and long-term affects on the world. Of course, overt communication days prior to an attempt would clearly indicate significant forethought and thus would contradict the notion of an impulsive attempt. Tellingly, Robins (1981) found that 70% of suicide dece￾dents engaged in such communications in the days before their death, usually more than once. Perhaps the most important limitation to the items in the various forms of the Planning subscale of the SIS is the item that most directly overlaps with other measures used to assess impulsiveness of attempts. Specifically, one item asks how much time was spent considering attempting suicide prior to the attempt, with the available answers being “impul￾sive; no premeditation,” “considered for <1 hr,” “considered for <1 day,” and “considered for >1 day.” Two primary issues render this item less valuable than it may first appear. First, Downloaded from psr.sagepub.com at Remen University of China on September 6, 2015