How We Ask Matters: the Impact of Question Wording in Single-Item Measurement of Suicidal Thoughts and Behaviors

The present study aimed to extend prior literature on single-item assessment by examining response consistency (1) between several commonly used single-item assessments of suicidal ideation, planning, and attempts, and (2) across three timeframes (past month, past year, and lifetime) commonly employed in the literature. Participants (N = 613) were recruited from an online community, Amazon Mechanical Turk (mTurk). Participants were administered three sets of four distinct single-items assessing suicidal ideation, suicidal planning, and suicide attempt history, respecitvely. Items were drawn from well-known large-scale studies (e.g., National Comorbidity Survey; World Health Organization Mental Health Survey Initiative, Youth Risk Behavior Survey) and commonly used suicide risk assessments (i.e., Self-Injurious Thoughts and Behaviors Interview). Through examinations of intraclass correlations and confirmatory factor analyses, findings suggested mixed response agreement across most outcomes and timeframes. Response inconsistency among items assessing suicidal ideation and among items assessing suicidal planning were partly attributed to minor, yet important, language differences. Given findings that even minor language changes in suicidal ideation and planning items may inflate or restrict prevalence estimates in a meaningful way, it will be important for researchers and clinicians alike to pay close attention to the wording of single items in designing research studies, interpreting findings, and assessing patient risk.