Research Trends Severity of Attempted Suicide as Measured by the Pierce Suicidal Intent Scale Merike Sisask 1,2 , Kairi Kõlves 1,3 , and Airi Värnik 1,2,4,5 1 Estonian-Swedish Mental Health and Suicidology Institute, Estonian Centre of Behavioral and Health Sciences, Tallinn, Estonia, 2 Tallinn University, Tallinn, Estonia, 3 Australian Institute for Suicide Research and Prevention (AISRAP), Brisbane, Australia, 4 University of Tartu, Tartu, Estonia, 5 National Prevention of Suicide and Mental Ill-Health (NASP) at Karolinska Institute and Stockholm County Council’s Centre for Suicide Research and Prevention, WHO Lead Collaborating Centre of Mental Health Problems and Suicide Across Europe, Stockholm, Sweden Abstract. Background: Suicidal intent is an essential feature of suicidal behavior. Previous research has been controversial and the need for further evidence has been pointed out. Aims: The aim of the present study was to characterize the severity of attempted suicide by extracting components of suicidal intent and analyzing levels of suicidal intent by gender, age, and variables indicating the severity of attempted suicide. Methods: Data on suicide attempters (N = 469) were collected in Estonia using WHO SUPRE-MISS methodology. To measure suicidal intent, a revised version of the Pierce Suicidal Intent Scale (PSIS) was used. Results: The level of suicidal intent was not gender-dependent, but rose with age. Males and females were also similar in terms of discrete components. Classified in age groups, their unequivocally expressed “wish to die” was similar, but equivocal communication (components termed “arrangements” and “circumstances”) increased with age. Middle-aged groups scored higher for the “alcohol/drugs” component. Psychiatric diagnosis, method of attempting suicide, and duration of hospitalization were linked to suicidal intent, but danger to life as assessed by interviewers was not. Conclusions: In suicide-risk assessment, results from a Suicidal Intent Scale contribute to clinical observation and add valuable information about a suicidal person’s real intention. Keywords: suicide attempt, Pierce Suicidal Intent Scale, components of suicidal intent, gender and age differences Introduction Suicidal intent is an essential component of any definition of suicide and suicidal behavior. This is primarily because it permits a distinction to be drawn between accidental and suicidal behavior (Andriessen, 2006). Suicidal intent has been defined as the seriousness or intensity of a person’s wish to terminate his or her life (Beck, Schuyler, & Her- man, 1974). The term level of suicidal intent is used to describe the intensity of a death wish (Hjelmeland & Haw- ton, 2004). The development of suicidal behavior has been charac- terized by the model of suicidal process, and suicidality has been described as a continuum from the lowest (weariness of life, suicidal ideation) to the highest (serious suicide at- tempt and completed suicide) level of suicidality (Maris, Berman, Silverman, & Bongar, 2000; Wasserman, 2001). Suicidal intent evolves during the suicidal process and lev- els of suicidal intent at different stages of the suicidal pro- cess may vary. Suicidal intent consists in a consciously ex- pressed wish to be dead, but there are also nonsuicidal con- scious or unconscious purposes, such as trying to manipu- late others or escape from an intolerable situation (Andries- sen, 2006; Hjelmeland, 1995; Hjelmeland & Hawton, 2004; Hjelmeland & Knizek, 1999; Michel, Valach, & Waeber, 1994). Moreover, suicidal behavior has clear ver- bal communication aspects, but nonverbal suicidal com- munication also expresses suicidal intent, one example be- ing the particular way in which a suicidal act is carried out, especially in the presence of others (Lester, 2001; Wasser- man, 2001). Psychometric scales are available to measure levels and various aspects of suicidal intent. One of the best-known scales, the Beck Suicide Intent Scale (BSIS), is not a sui- cide-risk scale as such, but rather a scale designed for use in research studies to classify suicide attempters (Bech, Raabaek Olsen, & Nimeus, 2001; Beck, Kovacs, & Weiss- man, 1979; Beck et al., 1974). A comparable scale, the DOI 10.1027/0227-5910.30.3.136 Crisis 2009; Vol. 30(3):136–143 © 2009 Hogrefe Publishing