The Living Ladder: Introduction and Validity Over 6-Month Follow-Up of a One-Item Measure of Readiness to Continue Living in Suicidal Patients.

OBJECTIVE

The ability to predict suicide outcomes is limited by the lack of consideration of protective factors. This study examined the validity of the Living Ladder, a measure of readiness to continue living among individuals thinking of suicide.

METHODS

The Living Ladder consists of one item that assesses an individual's readiness to continue living when thinking about suicide. Participants (N = 130) completed the Living Ladder in-person at baseline and by-phone at 1-, 3-, and 6-month follow-up. The prospective association of the Living Ladder with suicidal ideation and risk for a suicide attempt was examined using models adjusting for baseline ideation and suicide attempts, respectively.

RESULTS

Each rung on the Living Ladder was associated with 18% lower likelihood of suicidal ideation, OR (95% CI) = 0.82 (0.68, 0.96), and less severe suicidal ideation among those with ideation. Scores >2, indicating contemplation of living, were associated with 64% lower risk for a suicide attempt, HR (95% CI) = 0.36 (0.13, 0.98). Findings for suicidal ideation were replicated when administered by-phone.

CONCLUSIONS

The Living Ladder is a one-item measure that is prospectively associated with suicidal ideation and suicide attempts. Findings support the relevance of motivation to live to suicide outcomes.