Validity of the modular assessment of risk for imminent suicide in predicting short-term suicidality

Objective: The Modular Assessment of Risk for Imminent Suicide (MARIS) is a clinical assessment tool, consisting of four modules assessing (1) a pre-suicidal cognitive-affective state (Module 1); (2) patients’ attitudes toward suicide (Module 2); (3) clinicians’ assessment of suicide risk factors (Module 3); and (4) clinicians’ emotional responses to patients (Module 4) that assesses short-term suicide risk. Initial evidence provided evidence for its reliability and concurrent validity. The present study extended these findings by examining the MARIS’s predictive validity in relation to suicidal thoughts and behaviors at one-month follow-up. Methods: A sample of 1039 psychiatric patients (378 inpatients, 661 outpatients) and their clinicians (N = 144) completed a battery of measures at baseline; 670 patients completed the one-month follow-up assessment. Results: MARIS total scores predicted suicidal thoughts and behaviors at one-month follow-up, even after controlling for baseline suicidal thoughts and behaviors. Moreover, both Module 1 and the Distress subscale of Module 4 were uniquely associated with suicidal thoughts and behaviors at one-month follow-up, controlling for baseline suicidal thoughts and behaviors. Modules 2 and 3, on the other hand, exhibited poor internal consistency. Conclusion: Overall, both patient- and clinician-rated indices are uniquely predictive of suicidal thoughts and behaviors at one-month follow-up, highlighting the need for integrating clinicians’ emotional responses into suicide risk assessment. Pending replication and extension of these findings in external samples, a briefer, two-module version of MARIS (MARIS-2) may be such an integrative, psychometrically sound, and clinically useful instrument that can be utilized to assess short-term suicide risk.