The Suicide Behaviors Questionnaire-Revised (SBQ-R)

Abstract

The Suicide Behaviors Questionnaire-Revised (SBQ-R) is a concise, four-item self-report instrument widely utilized in clinical and research settings for the rapid screening and assessment of suicidality. Developed as an enhancement of the original Suicide Behaviors Questionnaire, the SBQ-R is designed to capture a comprehensive picture of suicidal risk across diverse populations, including lifetime history of ideation and attempts, recent frequency of suicidal ideation, communication of intent, and the perceived likelihood of future suicidal behavior. Its brevity, coupled with robust psychometric properties, establishes the SBQ-R as a valuable tool for identifying individuals who require immediate clinical intervention or further detailed assessment.

The total score for the SBQ-R ranges from 3 to 18. Established population-specific cutoff scores provide high sensitivity and specificity, allowing clinicians to effectively differentiate between non-suicidal individuals and those who are at elevated risk for suicidal acts.

Keywords

Suicide Behaviors Questionnaire-Revised (SBQ-R), suicidality, suicidal ideation, suicide attempt, risk assessment, clinical screening, psychological scale, self-report measure

Authors

A. Osman, C.L. Bagge, P.M. Guitierrez, B.A. Kooper, F.X. Barrios

Purpose

The primary objective of the SBQ-R is to serve as a fast, multidimensional screening instrument for quantifying various critical aspects of suicidal behavior and risk. Its design facilitates the swift identification of individuals who are at high risk in both general community and specialized psychiatric populations, thereby enabling timely and targeted intervention strategies.

The carefully constructed four items of the scale allow for the acquisition of essential risk information within a minimal administration time. The resulting total score is used to assess current risk status, measure the severity of past suicidal acts, and gauge the respondent’s subjective prediction of future suicidal potential.

Construct

The SBQ-R measures the overarching psychological construct of suicidality by segmenting it into four distinct, yet interrelated, dimensions. Each item on the scale corresponds directly to one of these dimensions of risk:

• Item 1: Lifetime History of Suicide Ideation and/or Attempt. This item assesses the respondent’s cumulative history concerning suicidal thoughts, formulated plans, and completed suicide attempts over their entire lifespan.
• Item 2: Frequency of Suicidal Ideation. This dimension quantifies the regularity with which the individual has experienced suicidal ideation specifically during the preceding twelve months.
• Item 3: Communication of Suicidal Intent. This item evaluates whether the individual has communicated or threatened suicidal intent or plans to other people.
• Item 4: Perceived Likelihood of Future Suicidal Behavior. This dimension measures the individual’s subjective assessment regarding the probability of them attempting suicide at some point in the future.

Validity

The validity of the SBQ-R has been extensively confirmed through rigorous research involving diverse samples, including both clinical and nonclinical populations. The scale demonstrates powerful effectiveness in discriminating between individuals who are suicidal and those who are not, establishing its strong diagnostic utility.

Key validation metrics were established in the foundational study by Osman et al. (2001). For the Adult General Population, a cutoff score of greater than or equal to 7 yielded a Sensitivity of 93% and a Specificity of 95%. For Adult Psychiatric Inpatients, a higher cutoff score of greater than or equal to 8 was necessary, maintaining strong classification metrics with Sensitivity at 80% and Specificity at 91%. The scale’s excellent discrimination ability is further supported by high Area Under the Receiver Operating Characteristic Curve (AUC) values. For example, the total SBQ-R score in Adult Inpatients achieved an AUC of 0.89 (considered Good discrimination).

Reliability

While the primary focus of the validation literature centers on predictive and concurrent validity, the consistent and high diagnostic accuracy reported across various studies strongly suggests that the SBQ-R possesses high internal consistency and acceptable test-retest reliability. The strong sensitivity and specificity metrics confirm that the scale consistently and accurately measures the intended construct, positioning it well among established brief screening measures in psychological assessment.

Factor Analysis

The SBQ-R is a highly brief, four-item scale specifically designed to capture four distinct, crucial facets of suicidality. Although detailed formal factor analysis results were not the primary focus of the initial validation summary, the scale’s structure inherently supports a multi-faceted model of suicidal risk. Each item acts as a unique contributor to the total risk score, reflecting the complexity of suicidal behavior rather than simply loading onto a single latent factor.

Instrument

Test Type: Self-report screening questionnaire

Format: Brief, 4-item, multiple-choice format

Language Available: English (Original)

Population Group: Clinical and Nonclinical populations (General population, Psychiatric Inpatients, College Students)

Age Group: Adolescents and Adults

Population Details: Applicable for use with individuals across the lifespan who may be at risk for suicidal behavior. The scale’s strong psychometric performance has been documented across diverse age and clinical groups.

Test Methodology: Respondents select the choice that best applies to their experience for each item. The scores are summed to yield a total risk score ranging from a minimum of 3 to a maximum of 18. Higher scores indicate greater levels of suicidal risk. The original PDF can be downloaded here: http://www.integration.samhsa.gov/images/res/SBQ.pdf.

Keywords

Suicide risk, SBQ-R scoring, psychodiagnostics, clinical assessment, suicidality screening, Area Under the Curve (AUC), sensitivity, psychometric scale, cutoff scores

Authors

Author ORCID Identifier: Not provided in source.

Affiliation Email addresses: Not provided in source.

Correspondence Address: Not provided in source.

Permissions & Fee and Test Year

The revised version of the scale, the SBQ-R, was copyrighted in 1999 by A. Osman et al. Permission for use was explicitly granted by A. Osman, MD. The SBQ-R is generally recognized as a public domain or low-cost instrument, making it readily accessible for widespread use in both clinical practice and academic research. Users should, however, always verify the most current permission requirements directly with the primary author or the relevant academic institution prior to implementation.

Reference’s

Osman A, Bagge Cl, Guitierrez PM, Kooper BA, Barrios FX. The Suicidal Behaviors Questionnaire-Revised (SBQ-R): Validation with clinical and nonclinical samples. Assessment, 2001, 8(5), 443-454.

Items of the The Suicide Behaviors Questionnaire-Revised (SBQ-R)

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

Scoring Guidelines and Psychometric Data

The total score for the SBQ-R is calculated by summing the points associated with the selected responses across all four items. The resultant total score can range from a minimum of 3 to a maximum of 18 points.

Item 1 Scoring: Lifetime Suicide Ideation and/or Suicide Attempts

Item 2 Scoring: Frequency of Suicidal Ideation Over the Past 12 Months

Item 3 Scoring: Threat of Suicide Attempt

Item 4 Scoring: Likelihood of Suicidal Behavior in the Future

Cutoff Scores and Diagnostic Accuracy

The effectiveness of the SBQ-R in classifying suicidal risk is summarized by its sensitivity and specificity relative to established cutoff scores for different populations, demonstrating its high diagnostic utility.

Further diagnostic performance metrics, including Positive Predictive Value (PPV) and the Area Under the Receiver Operating Characteristic Curve (AUC), confirm the scale’s strong psychometric quality, particularly when used in high-risk clinical settings.