Single-item measurement of suicidal behaviors: Validity and consequences of misclassification
Open accessAbstract
Suicide is a leading cause of death worldwide. Although research has made strides in better defining suicidal behaviors, there has been less focus on accurate measurement. Currently, the widespread use of self-report, single-item questions to assess suicide ideation, plans and attempts may contribute to measurement problems and misclassification. We examined the validity of single-item measurement and the potential for statistical errors. Over 1,500 participants completed an online survey containing single-item questions regarding a history of suicidal behaviors, followed by questions with more precise language, multiple response options and narrative responses to examine the validity of single-item questions. We also conducted simulations to test whether common statistical tests are robust against the degree of misclassification produced by the use of single-items. We found that 11.3% of participants that endorsed a single-item suicide attempt measure engaged in behavior that would not meet the standard definition of a suicide attempt. Similarly, 8.8% of those who endorsed a single-item measure of suicide ideation endorsed thoughts that would not meet standard definitions of suicide ideation. Statistical simulations revealed that this level of misclassification substantially decreases statistical power and increases the likelihood of false conclusions from statistical tests. Providing a wider range of response options for each item reduced the misclassification rate by approximately half. Overall, the use of single-item, self-report questions to assess the presence of suicidal behaviors leads to misclassification, increasing the likelihood of statistical decision errors. Improving the measurement of suicidal behaviors is critical to increase understanding and prevention of suicide.
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Self-report measures are susceptible to misattribution and retrospective bias.
“Self-reports are prone to misattributions and retrospective biases (132)”
From Neural correlates associated with suicide and nonsuicidal self-injury in youth (2021) · cites this paper as [132]
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- Authors
- Millner, A. J., Lee, M. D., & Nock, M. K.
- Affiliations
- Harvard University (US)
- The University of Texas at Austin (US)
- Corresponding author
- Millner, Alexander J.
- Venue
- PLOS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2015-10-23
- Volume
- 10
- Issue
- 10
- Pages
- e0141606
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC4619664
- OpenAlex
- W2169699730
- Cited by
- 361
- References
- 20
- Citations by year
- 2026: 32 · 2025: 48 · 2024: 34 · 2023: 36 · 2022: 35 · 2021: 46 · 2020: 33 · 2019: 33 · 2018: 34 · 2017: 21 · 2016: 8
- FWCI
- 26.08
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
- RePEc: Research Papers in Economics (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Figshare (submittedVersion, cc-by)
- OSF Preprints (OSF Preprints) (submittedVersion)
- Funders
- John D. and Catherine T. MacArthur Foundation
- Harvard University
- Dr Mortimer and Theresa Sackler Foundation
- Topics
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Social Sciences › Decision Sciences › Management Science and Operations Research › Psychometric Methodologies and Testing
- Social Sciences › Sociology and Political Science › Survey Methodology and Nonresponse
- Keywords
- suicidal behavior, suicidal ideation, suicide attempts, misclassification, measurement validity, statistical power, false positives, response options, suicide prevention
- MeSH terms
- Suicide Prevention, Adolescent, Adult, Aged, Female, Humans, Male, Middle Aged, Surveys and Questionnaires, Suicide, United States, Young Adult
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