Attitudes Towards Suicide

Abstract

The Attitudes Towards Suicide (ATTS) questionnaire is a specialized and comprehensive psychometric instrument designed to measure prevailing public and personal attitudes toward suicide. Developed by Renberg and Jacobsson, the scale was initially utilized in a large-scale, national longitudinal study conducted in Sweden across 1986 and 1996.

The ATTS is structured in three distinct sections to capture the multidimensional nature of the construct: Section A assesses the respondent’s personal contact and exposure to suicidal problems within their social sphere; Section B contains 37 core items measuring attitudes, scored on a 5-point Likert scale; and Section C gathers essential demographic data alongside self-reported history of suicidal behavior. The acceptable psychometric properties of this instrument have been formally documented in academic literature (Renberg & Jacobsson, 2003).

Keywords

Suicide, Suicidal Ideation, Attitudes, Longitudinal study, Public Health, Mental Illness, Crisis Intervention, Likert scale, Psychometrics

Authors

Renberg, E., Jacobsson, L.

Purpose

The primary function of the ATTS questionnaire is epidemiological: to systematically quantify, monitor, and track shifts in public attitudes towards suicide within a national population over extended periods. The scale was specifically engineered to generate robust data essential for extensive research, particularly the large-scale longitudinal study carried out in Sweden.

Beyond simple measurement, the instrument serves to delineate prevailing societal beliefs concerning the causes, moral justification, preventability, and intervention associated with suicide. By integrating respondent data on personal experience (contact with suicidal issues) with expressed attitudes and self-reported suicidal behavior, the ATTS provides a rich, contextually grounded dataset for public health research and targeted prevention efforts.

Construct

The ATTS is designed to measure the complex, multidimensional psychological construct of Attitudes Towards Suicide. This construct is operationalized through 37 distinct statements that probe several critical domains of opinion and belief regarding self-harm and death by suicide:

• Justification and Acceptance: Beliefs regarding the conditions under which suicide might be considered acceptable, such as in cases of severe or incurable disease.
• Preventability and Intervention: Opinions concerning the efficacy of intervention strategies and the perceived moral or human duty to prevent suicide.
• Stigma and Mental Health: The degree to which respondents associate suicide with mental illness and their willingness to openly discuss the topic.
• Etiology and Intent: Beliefs about the underlying drivers of suicidal actions, including whether they are viewed as impulsive, premeditated, or motivated by factors like revenge, loneliness, or conflict.

A distinctive feature of the ATTS is its inclusion of Section A, which measures the respondent’s degree of contact with the suicide problem within their immediate social circle, ensuring that the measured attitudes are assessed in relation to personal exposure and experience.

Validity

While the source abstract does not provide specific empirical validity metrics, such as factor loadings or criterion validity coefficients, the developers assert that the Attitudes Towards Suicide instrument possesses acceptable psychometric properties. These detailed properties were subsequently reported in a separate academic publication (Renberg & Jacobsson, 2003).

The scale demonstrates strong content validity, which is supported by the comprehensive nature and breadth of the 37 attitude items. These items collectively span a wide spectrum of clinically and socially relevant aspects of suicide, including complex issues such as medical ethics (e.g., the right to die when suffering from incurable disease), crisis intervention efficacy, and the social impact on family members.

Reliability

Specific statistical reliability coefficients, such as Cronbach’s alpha for internal consistency or test-retest reliability measures, are not explicitly provided in the source documentation. However, the developers confirm that the overall psychometric properties of the ATTS have been formally published. This confirmation implies that the scale successfully underwent standard reliability testing protocols required for a rigorous research instrument intended for repetitive, large-scale application in epidemiological studies.

Factor Analysis

The fundamental architecture of the ATTS, which incorporates 37 diverse attitude items designed to capture “multidimensional attitude areas,” strongly suggests that the scale development process necessitated rigorous factor analysis. This statistical technique would have been crucial for reducing the large number of items into coherent, underlying attitude clusters or dimensions that the scale effectively measures.

Although the precise factor structure is not documented in the abstract, an examination of the item content suggests the presence of several distinct factors, including:

• Fatalism/Impulsivity: Items related to the inevitability of suicide once a decision is made, and whether suicidal actions are primarily impulsive or premeditated (e.g., Items 7, 9, 13, 25).
• Compassion/Help-Seeking: Items assessing the perceived duty to intervene and the possibility of offering help during a suicidal crisis (e.g., Items 4, 12, 29, 33).
• Right to Die/Justification: Factors related to the moral acceptance of suicide, particularly in the context of incurable suffering or disease (e.g., Items 8, 27, 32, 37).

Instrument

Test Type: Self-report Questionnaire/Survey Instrument

Format: Mixed. The core attitude items (Section B) are measured using a 5-point Likert scale (ranging from 1=Strongly disagree to 5=Strongly agree). The contact and demographic sections (A and C) utilize categorical response scales (e.g., Never/Some time/Often or Yes/No).

Language Available: Originally developed and deployed in Swedish.

Population Group: General Population.

Age Group: Adults (Primarily utilized in large-scale general population surveys).

Population Details: The instrument was validated and first deployed within the general population of Sweden during national surveys conducted in 1986 and 1996.

Test Methodology: The full questionnaire is comprehensive, comprising three primary sections: A. Contact with the suicide problem; B. Attitudes (37 statements); and C. Demographic and Self-reported Suicidal Behavior. Some research applications have utilized a shorter version focusing predominantly on the core attitude statements and attempts reported in the previous year.

Keywords

Epidemiology, Public Opinion, Suicidal Behavior, Mental Health Stigma, Crisis Intervention, Factor analysis, Psychometric properties, Ethical considerations, Sweden

Authors

Author ORCID Identifier: Not specified in source.

Affiliation Email addresses: Not specified in source.

Correspondence Address: Not specified in source.

Permissions & Fee and Test Year

The Attitudes Towards Suicide scale was developed and first utilized in major national surveys conducted in 1986 and 1996. Information regarding current licensing fees, official copyright, and specific permissions required for non-academic or international use is not detailed in the source material. Researchers intending to implement the ATTS instrument should contact the primary authors, E. Renberg or L. Jacobsson, directly for formal authorization and current usage guidelines.

Reference’s

The original PDF concerning a study utilizing the ATTS questionnaire and detailing its application can be downloaded here: http://www.phmed.umu.se/digitalAssets/30/30046_2006-10-ma-yousuf-bhuiyan.pdf

Specific psychometric validation is documented in:

• Renberg, E., & Jacobsson, L. (2003). [Specific paper title documenting psychometric properties of ATTS].

Questions regarding suicidal behavior were derived, in part, from earlier work:

• Paykel E et al. (1974). [Specific paper title documenting suicidal behavior questions].

Items of the Attitudes Towards Suicide

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

A. Contact with the suicide problem

Initially there are some questions about your experiences of suicide problems in your closest surroundings. Please mark with a cross the appropriate alternative. (Items are scored never‚ some time‚ often and not applicable).

1. Has any of the following persons (separate items for father/mother‚ brother/sister‚ child‚ partner‚ other relatives‚ friends‚ work-/schoolmates‚ others)
   1. – made a suicide attempt
   2. – expressed suicidal thoughts‚ plans or treats
2. Is there at this very moment any person in your closest surrounding that you know has suicidal thoughts? (Similar alternatives‚ items scored no‚ yes and not applicable)
3. Has any of the following persons committed suicide? (similar alternatives‚ items scored no‚ yes and not applicable)

B. Attitudes

The following questions concern your opinion about suicide. Please mark with a cross the alternative that you find is in best accordance with your opinion. There are no rights or wrong answers!

(Items are scored on the following scale: strongly agree‚ agree‚ undecided‚ disagree‚ strongly disagree)

4. It is always possible to help a person having suicidal thoughts.
5. Suicide can never be justified.
6. Committing suicide is among the worst thing to do to ones relatives.
7. Most suicide attempts are impulsive actions.
8. Suicide is an acceptable means to terminate an incurable disease.
9. Once a person has made up his/her mind about committing suicide no one can stop him/her
10. Many suicide attempts are made because of revenge or to punish someone else.
11. People who commit suicide are usually mentally ill.
12. It is a human duty to try to stop someone from committing suicide.
13. When a person commits suicide‚ it is something that he/she has considered for a long time.
14. There is a risk of evoking suicidal thoughts in a person’s mind if you ask about it.
15. People who make suicidal threats seldom complete suicide.
16. Suicide is a subject that one should rather not talk about.
17. Loneliness could for me be a reason to take my life.
18. Almost everyone has at one time or another thought about suicide.
19. There may be situations where the only reasonable resolution is suicide.
20. I could say that I would take my life without actually meaning to do so.
21. Suicide can sometimes be a relief for those involved.
22. Suicides among young people are particularly puzzling since they have everything to live for.
23. I would consider the possibility of taking my life if I were to suffer from a severe‚ incurable‚ disease.
24. A person once they have suicidal thoughts will never let them go.
25. Suicide happens without warning.
26. Most people avoid talking about suicide.
27. If someone wants to commit suicide‚ it is his or her business and we should not interfere.
28. It is mainly loneliness that drives people to suicide.
29. A suicide attempt is essentially a cry for help.
30. On the whole‚ I do not understand how people can take their lives.
31. Usually relatives have no idea about what is going on when a person is thinking of suicide.
32. A person suffering from a severe‚ incurable‚ disease expressing wishes to die should get help to do so.
33. I am prepared to help a person in a suicidal crisis by making contact.
34. Anybody can commit suicide.
35. I can understand that people suffering from a severe‚ incurable‚ disease commit suicide.
36. People who talk about suicide do not commit suicide.
37. People do have the right to take their own lives.
38. Most suicide attempts are caused by conflicts with a close person.
39. I would like to get help to commit suicide if I were to suffer from a severe‚ incurable disease.
40. Suicide can be prevented.

C. Demographic and Behavioral Items

41. Gender
42. Age
43. Education (-9 years‚ 10-12 years‚ 13 years or longer)
44. Have you ever made an attempt to take your own life? Last year and earlier in life on a yes‚ no scale‚ followed by number of attempts