We found that the BBSCS fits a unidimensional component structure. With approximately 56% of the common variance accounted for the six items in the measure. Additionally, the tool demonstrated good reliability (internal consistency) estimates, displayed moderate positive correlations between BBSCS and perceived subscale of INK and revealed good discriminant validity by its ability to distinguish between respondents with and without prior history of suicidal behavior.
Our findings have three main implications of theoretical and clinical significance. First, our findings provide preliminary support for assessment of the suicide cognition construct in the Bangladesh setting. Next, it also supports the use of BSCS to assess suicide cognitions among Bangladeshi adults. Finally, the unidimensional component structure of BSCS supports the use of BSCS as a continuous measure to assess suicide belief system in our setting.
From a theoretical standpoint, the suicide cognitions scale (SCS) intends to capture enduring vulnerability to suicide by assessing the source of suicide-related hopelessness within self and others [24]. The within-self theme addresses reasons for hopelessness such as inability to do anything to solve one’s life problems (resolvability) [25, 26], beliefs about self as unlovable and one’s emotional circumstances as unbearable. The within-other theme assesses the construct of perceived which, together with acquired capability for suicide [29], are central to understanding chronic and enduring vulnerability to suicide as per the IPT S [8]. The moderate correlation we observed between BBSCS scores and perceived subscale of IN QB supports this understanding and implies that the SCS items may tap into residual suicide risk by indicating underlying vulnerability for suicide.
Clinically, this also implies that the SCS may be useful to identify a subset of individuals with enduring suicide risk. In such individuals, the suicide belief system, characterized as described earlier by thoughts of resolved results in heightened vulnerability for reemergence of acute suicidal crisis following the resolution of an acute suicidal episode; in other words, there is a residual risk state that confers a greater likelihood of experiencing repeated suicidal crisis over time.
Prior researches across settings [14, 15, 30] have supported the role of these constituent components in making up the suicide belief system and its clinical utility in assessing chronic enduring suicide risk. This is also consistent with contemporary models of risk conceptualization in suicide, such as the FVT of suicide [13], that conceive suicide risk along two planes: chronic and acute risk. By virtue of its good discrimination between respondents with and without prior suicidal behavior, the BBSCS may be used in our setting to direct targeted suicide prevention activities by identify a subset of suicide at tempters at greater risk for future suicidal crisis.
The BSCS has shown robust psychometric properties for the BSCS across clinical and nonclinical samples [18]. Our results from a different cultural setting further strengthen and support the use of BSCS among adolescents and young adults in Bangladesh as a screening measure to identify those with enduring vulnerability to suicide. This is particularly relevant because of the paucity of assessment instruments for chronic suicide risk, which has historically received less clinical and research attention compared to acute risk. The brevity, reliability, and validity of BSCS in our setting mean that it can be employed in busy outpatient settings to identify chronic risk of suicide and supplement conventional approaches to suicide risk assessment and triaging. As an aside, documenting the chronic risk can be helpful to the client’s family, by flagging the enduring vulnerability, and also to the treating physician, for whom, in the absence of such documentation, a future suicide episode may be seen as a legal liability [31]. We assessed the psychometric properties of BSCS in Bangle. Which is the first attempt in the country. Nevertheless, there are several limitations of the study that should be considered while considering the study findings. We only determined a single form of reliability (internal consistency). Assessment of other forms of reliability like test-retest and reliability would assess the construct more vigorously. We recommend further studies to assess those. We validated the instrument in a specific group of populations (nonclinical sample and medical and university students) which may challenge the generalization of the findings. We included the institutions purposively. Which could be a source of selection biases. However, our institutions covered both public and private organization that may reflect the all sphere of society. The study was conducted based on the responses collected by Google Forms which may be a potential source of biases while face-to-face interview is more reliable and rigorous in assessing the psychological disorders. This study assessed the psychometric properties of BSCS in Bangle among students. Which found acceptable reliability and validity. However, cautious interpretation is necessary while generalizing the study results. Further studies could test the validation. Especially among clinical samples to assess the predictive validity of the instrument. Regular utilization of the instrument in clinical and research would foster the better services for suicide prevention in the country.
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