Psychiatry Research 215 (2014) 471476

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Psychiatry Research
journal homepage: www.elsevier.com/locate/psychres

Validation of the French version of the Suicidal Ideation Questionnaire

among adolescents
Catherine Potard a,n, Violaine Kubiszewski b, Guillaume Gimenes c, Robert Courtois c,d
a
University of Reims Champagne-Ardenne, EA 6291, 57 rue Pierre Tailtinger, 51096 Reims, Cedex, France
b
University of Franche Comt, EA 3188 Besanon, France
c
University of Franois Rabelais, Department of Psychology, EA 2114 Tours, France
d
Psychiatric University Clinic, University Hospital of Tours (CHRU), Tours, France

art ic l e i nf o a b s t r a c t

Article history: Teenage suicide is a major public health issue in Western societies, especially in France. An instrument to
Received 3 July 2013 measure suicidal thoughts in French adolescents and thus identify the teenagers at risk is urgently
Received in revised form required. The aim of this study was to validate a French version of the Suicidal Ideation Questionnaire
11 November 2013
(SIQ) for use with teenagers. Respondents (n 956, age range 1418.0) completed the SIQ and other
Accepted 25 November 2013
Available online 4 December 2013
convergent measures (self-esteem, psychic morbidity, anxiety, and personality) for three validation steps
(general and clinical samples). A conrmatory factor analysis was performed on the SIQ. The study
Keywords: supported a 30-item one-factor model, similar to the original questionnaire, with moderate model t
Suicidal ideation indices (2/ddl 3.21; RMSEA 0.05; CFI 0.87; GFI 0.92). Signicant correlations (  0.22 to 0.74) were
Assessment
found with convergent measures among general (n 871) and psychiatric samples (n 38). A high
Adolescence
internal consistency was found with a reliability coefcient of 0.91. The results conrm the psychometric
qualities of the questionnaire for French adolescents.
& 2013 Elsevier Ireland Ltd. All rights reserved.

1. Introduction Suicidal ideation concerns imaginary thoughts of one's own

In France, suicide is currently the second leading cause of
mortality among teenagers and young adults (1524 years), with
approximately 600800 deaths per year (Aouba et al., 2009). The
main public health organizations estimate that 6.5 of French
teenagers attempt suicide every year. This rate is particularly
alarming as it is largely underestimated, many suicide attempts
not being reported. France is especially affected by this phenom-
enon, having the third highest adolescent suicide rate in Europe
(World Health Organization, 2007). Classically, a distinction is
made between three aspects of suicide: suicidal ideation, suicide
attempts and completed suicides. This distinction expresses a
continuum between suicidal thoughts and death by suicide
(Neeleman et al., 2004; Yoder et al., 2008; Thompson et al.,
2012). It has been established that there is a close link between
the severity of suicidal thoughts and the risk of attempting suicide.
Some authors even postulate that teenagers who have suicidal
thoughts and those who attempt suicide are part of the same at-
risk population (Kovac and Garrisson, 1985; Pirkis et al., 2000;
McAuliffe, 2002).
n
Corresponding author. Tel.: 33 326918062.
E-mail address: catherine.potard@univ-reims.fr (C. Potard).
death. When these thoughts assume not only an imaginary nature
but also involve formulation of a plan (e.g. contemplating plans
and preparations for self-harm), the term suicidal intent is gen-
erally used. Intention is a crucial link between thought and action
(McAuliffe, 2002). Suicide attempt describes a more or less clearly
thought-out action that does not lead to death. On the other hand,
the term suicide is used to describe an action resulting in death.
Thoughts and cognitions relating to suicide are identied as a key
element in the risk of attempting suicide. Thus, Reynolds (1989)
considered suicidal ideation as further reaching than the simple
thought of one's own death, but also involves plans, behaviors,
and outcomes of a potential suicide attempt (e.g. reactions to
others parents). The presence and severity of suicidal thoughts
can also be considered as an indicator of the risk of committing a
suicidal act. However, it should be stressed that it is common for
adolescents to have thoughts of death and that this forms an
integral part of their development (Evans et al., 2005). In some
cases, these suicidal thoughts can become intrusive and may lead
to planning the suicidal act. There is a developmental gradient of
the frequency of suicidal thoughts, which are more common
among adolescents and young adults than in other age groups
(Institut de Veille Sanitaire, 2011; Centers for Disease Control and
Prevention, 2011). During adolescence, the prevalence of suicidal
thoughts tends to increase with age: among 1415 year-olds, 17%
of boys and 29% of girls declare that they have suicidal ideas, 22%

0165-1781/$ - see front matter & 2013 Elsevier Ireland Ltd. All rights reserved.
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472 C. Potard et al. / Psychiatry Research 215 (2014) 471476

and 33% of 1617-year-old boys and girls respectively, and 25% and
36% of those aged 18 and over (Schmidtke et al., 1996). Therefore,
early screening of severe suicidal ideation in teenagers is crucial
for prevention. Currently, there is no validated tool to evaluate
suicidal ideation among adolescents in France and an instrument
to measure suicidal thoughts and thus identify teenagers at risk is
urgently required. Moreover, due to the lack of a validated scale,
French data on suicidal ideation cannot be strictly compared with
those of studies carried out in other countries.
The Suicidal Ideation Questionnaire (SIQ), proposed by
Reynolds (1988), assesses the frequency of suicidal ideation among
1418 year-olds (there is also a junior version SIQ Jr and an adult
version ASIQ). It is used internationally (Pinto et al., 1997;
Carlton and Deane, 2000; Gutierrez and Osman, 2009;
Muehlenkamp and Peter, 2011; Guan et al., 2012) and has the
advantage of being relatively short (30 items in its original
version). It was designed to measure the severity of suicidal
ideation and also to identify the people at risk in relation to a
specic cut-off level (Reynolds, 1991). Reynolds (1988) reported
three factors within the scale: a 25-item factor accounting for
89.6% of the variance, a 3-item factor, and a 2-item factor. These
three factors are: (1) wishes and plans to commit suicide, (2) focus
on the responses and aspects of others, and (3) morbid ideation.
Nevertheless, the one-factor solution proposed initially by
Reynolds (1988) remains relevant with a good explanation of the
variance and satisfactory internal consistency. It can be argued
that the rst factor was sufciently explanatory and that the two
additional factors were extraneous, as suggested by Reynolds
(1988) and Pinto et al. (1997). From this point of view, Reynolds
(1988) considered a cut-off score of 41 (89th percentile of the
normative sample) as an indicator of potentially signicant psy-
chopathology and acute suicidal risk.
For a measuring instrument to be used with condence it must
be reliable, sensitive and specic. As such, the SIQ has been
validated in various languages or cultures, but not in French
(Keane et al., 1996; Abdel-Khalek and Lester, 2007). These studies
demonstrated good internal consistency and sensitivity ( 0.97
and test-retest 0.72) (Pinto et al., 1997; Winters et al., 2002). This
instrument therefore represents a potentially relevant tool for
Descriptive statistics of age and SIQ scores for each study are presented in
Table 1.
2.2. Study 1
2.2.1. Objective
The aim of this study was to test the internal validity of the SIQ by evaluating its
structure through a conrmatory factorial analysis, using AMOS 20 software. This
study also aimed to evaluate convergent validity by examining the pattern of
correlations between the SIQ and various related psychological constructs in
adolescence (self-esteem, overall mental health, and separation anxiety).
2.2.2. Method
Participants and procedure: After excluding students with three or more values
missing on the SIQ, there were 871 participants: 62.5% were girls (n 536) and
37.5% were boys (n 321), with no sex data for 13 subjects. Participants were
French students attending state schools (n 8) or university (n 2) in the Indre-et-
Loire dpartement, France. The age of participants ranged from 14.0 to 18.0 years
with a mean age of 16.35 years (SD 1.44) (see Table 1). School level was
distributed as follows: middle school (n 241, 27.7%), high school (n 611, 70.1%),
university (rst year) (n 19, 2.2%). In order to limit fatigue and contamination bias
between questionnaires, pupils answered no more than 90 items (including
sociodemographic data), i.e. a maximum of three questionnaires. After obtaining
the permission of the school administrators, the parents, and the adolescents
themselves, the questionnaires were handed out in class, either by the authors or
by the head teacher. Classes were selected at random by the school administrators.
All the data were collected through the self-administered questionnaires. The
purpose of the study and the questionnaire procedure were explained, emphasiz-
ing the condentiality and anonymity of the data. Clear and precise instructions
were given, and the importance of giving honest answers was stressed. The
number of participants answering each questionnaire is presented in Table 3.
Instruments: Participants completed measures of specic psychological con-
structs with the following self-report questionnaires:
The Suicidal Ideation Questionnaire (SIQ): This is a 30-item self-report (Reynolds,
1988) measures specic thoughts and cognitions about suicide and death during
the past month on a 7-point scale ranging from 0 never had any thoughts to 6
almost every day. Each item deals with a specic suicidal thought (e.g., I thought
about how others would feel if I killed myself, I thought that killing myself would
solve my problems). It was not designed to predict suicide, but to identify a
broader range of individuals who have thoughts of death. Total scores range from
0 to 180 with higher scores indicating a greater severity of suicidal ideation. The
SIQ was rst translated into French by two English-speaking. Back-translation
methods were used to ensure compatibility between the English and French
versions, with the help of a native English speaker. In our study, Cronbach's alpha
was 0.97.

French-speaking health professionals. Previous validation studies

of this questionnaire have frequently used concomitant measures Table 1
Descriptive statistics for all samples.
of anxiety/depression (Mazza and Reynolds, 1998; Spirito et al.,
2003), self-esteem (Reynolds, 1991) or emotional distress, in Studies and samples N Age SIQ
general or psychiatric samples (Huth-Bocks et al., 2007). For the
latter, antecedents of suicide attempts have been used as a validity M SD M SD
criterion. The aim of this study was therefore to investigate the
Study 1
validity of a French version of the SIQ by examining its psycho- Total 871 16.35 1.44 29.28 34.74
metric properties among a sample of French adolescents (age Girls 536 16.28 1.39 33.98 36.61
range 1418). Boys 321 16.88 1.41 21.42 29.57

Study 2
Total 38 15.66 1.43 74.66 48.57
2. Methods
Girls 23 15.13 1.39 61.50 43.53
Boys 15 16.47 1.09 94.85 50.35
2.1. Overview of the studies
Study 3
Total 56 18.32 0.62 19.03 16.17
Three studies were conducted for the purpose of validating the SIQ among Girls 46 18.31 0.59 18.41 17.02
French adolescents, investigating three aspects of its psychometric qualities Boys 10 18.40 0.70 21.90 11.74
(internal and convergent validity, reliability at 2 weeks).
Study 1 assessed the structure of the SIQ by comparing a one-dimensional
model of this scale with a three-factor model. The construct validity was
investigated by evaluating correlations between SIQ scores and related specic
psychological constructs. Psychological constructs were included because higher Table 2
levels of suicidal thoughts are thought to be related to lower psychological Fit indices of the conrmatory factor analysis models.
functioning.
Study 2 investigated the results of the French version of the SIQ administered to 2/ddl GFI AGFI RMSEA CFI
a clinical population subdivided into three sub-groups: patients who had
attempted suicide (SA), patients with suicidal ideation (SI), and a psychiatric Model 1 3.21 0.92 0.91 0.05 0.87
control group (PC). Model 2 2.99 0.93 0.91 0.05 0.88
Study 3 evaluated the temporal stability of the SIQ with test-retest correlations.
 C. Potard et al. / Psychiatry Research 215 (2014) 471476
Table 3
Correlations between the SIQ and related con-
structs (r de Spearman) in general population.
SIQ
Self-esteem (n 292)
General self-esteem  0.58nnn
Social self-esteem  0.29nnn
Family self-esteem  0.49nnn
Academic self-esteem  0.33nnn
General Health (n 353)
Social function 0.32nnn
Anxiety and Depression 0.50nnn
Separation anxiety (n 292) 0.40nnn
Personality (n 405)
Extraversion ns
Neuroticism 0.39nnn
Agreeableness ns
Conscience  0.22nnn
Openness ns
ns: Non-signicant.
nn
p o0.01.
nnn
p o 0.001.
The Coopersmith Self-Esteem Inventory (SEI) (Coopersmith, 1984; Coopersmith,
1987): The SEI school form (for 12-24 years old) consists of 58 items describing
typical feelings, emotions, cognitions and behavior in everyday situations (e.g.
Things usually dont bother me, I nd it very hard to talk in front of the class).
Participants indicate whether items describe themselves or not (with two possible
responses: like me or unlike me). The SEI is composed of a general subscale and
three additional subscales evaluating self-esteem in three areas: social, family, and
academic. Each score corresponds to the total scores of the subscale. Higher scores
indicate higher levels of self-esteem. The reliability of this questionnaire is 0.86.
The General Health Questionnaire-12 (GHQ-12) (Goldberg, 1979; Goldberg and
Williams, 1988): The General Health Questionnaire 12 is a short measure of current
mental health developed by Goldberg and Williams (1988). Respondents rate their
recent experience of a particular mood or behavior over the previous 4 weeks (e.g.
feeling unhappy and depressed, lacking in condence, enjoying normal activities)
on a 4-point scale (less than usual, no more than usual, rather more than usual,
and much more than usual). The GHQ-12 focuses on two major areas: (1) Social
dysfunction and (2) Anxiety and Depression. A total score can also be calculated
by summing all the subscale scores. Higher scores indicate a psychiatric disorder.
GHQ-12 is reliable ( 0.78).
The Big Five Inventory Fr (BFI-Fr) (John, 1990; John and Srivastava, 1999; Plaisant
et al., 2010): The French version of the Big Five Inventory consists of 45 items. Each
item is a short sentence based on adjectives characterizing the Big Five personality
dimensions, namely: Extraversion (energy, enthusiasm), Agreeableness(altruism,
affection), Conscientiousness (constraint, controlling impulses), Neuroticism(ne-
gative affectivity, nervousness), and Openness (originality, open-mindedness)
(John and Srivastava, 1999; John et al., 2008). The subject is asked to quantify each
characteristic (for example: e.g. be talkative; having tendency to criticize others;
work conscientiously) on a 5-point Likert scale ranging from strongly disapprove
to strongly approve. A mean score is calculated for each dimension. The Big Five
Inventory Fr is valid and sensitive to adolescents and young adults (Plaisant et al.,
2010). In our study, Cronbach's alpha was 0.65.
The Separation Anxiety Symptom Inventory (SASI) (Silove et al., 1993; Brandibas
et al., 2010): The SASI is a 15-item self-report measure of separation anxiety
symptoms. It was initially designed to recognize the symptoms of separation
anxiety in adolescence. In addition to identifying diverse symptoms, a separation
anxiety score can be calculated. It can be used clinically to identify intrusive
anxious symptomatology and difculties in parent-child relationships. The 15 items
are each scored on a Likert scale ranging from 0 to 3 and are summed to give a total
score. Higher scores indicate a higher level of anxiety separation. Cronbach's alpha
obtained in our study shows good internal consistency ( 0.85).
2.2.3. Results
A conrmatory factor analysis (CFA) was conducted to test the one-dimensional
or three-dimensional structure of the SIQ. First, we carried out a CFA to test the t
of a one-factor model using an asymptotically distribution-free (ADF) method (for
scores not normally distributed). Next, we used a second CFA to test a three-factor
model to evaluate the relevance of the distinction between wishes and plans to
commit suicide, focus on the responses and aspects of others, and morbid
ideation, based on the ndings of Reynolds (1988, 1989) and Pinto et al. (1997).
The CFA provides information indicating how well the data t the proposed
hypothetical model. The four indices considered to test the goodness-of-t of the
model were chi-square, the goodness-of-t index (GFI), the Bentler comparative t
473
index (CFI), and the root mean square error of approximation (RMSEA). Both the
GFI and the CFI range from 0 to 1.00, with a value greater than 0.90 being generally
taken to indicate an acceptable t. RMSEA values below 0.10 may be considered
good and the lower the better (Hu and Bentler, 1999).
Table 2 displays the t indices of the two models.
In this study, while some indices for both models were good (2/ddl, RMSEA,
GFI, AGFI) and some poor (CFI), they were reasonably similar, indicating acceptable
t. Another criterion on which models can be compared is the expected cross-
validation index (ECVI). The ECVI value of model 2 (1.8) was slightly lower than that
of model 1 (1.9). The three-factor model (model 2) provided only slight improve-
ment, in accordance with the exploratory factor ndings of the original version and
with replicating studies published in other languages and cultures (Reynolds, 1988;
Keane et al., 1996; Pinto et al., 1997; Abdel-Khalek and Lester, 2007), indicating
again the suitability of the one-dimensional structure of the SIQ.
The construct validity of the SIQ was evaluated by examining the relationship
between the participants' Suicidal Ideation Questionnaire scores and variables that
have been linked to suicidal ideation: low self-esteem, poor general health, anxiety
and neuroticism. We used Spearman correlations (Table 3).
2.3. Study 2
2.3.1. Objective
The aim of this study was to test the relevance and validity of the SIQ in a
sample of psychiatric in-patients.
2.3.2. Method
Participants and procedure: All participants were teenagers in a psychiatric
hospital specialized in treating adolescents (Psychiatric University Clinic of Tours,
France) (for details see Table 1). The sample consisted of 38 adolescents with a
mean age of 15.66 years (SD 1.43, range 14.0018.33), with 60.5% girls (n 23) and
39.5% boys (n 15). There was a signicant age difference between boys and girls,
boys being older (t(36)  3.15, p o 0.01). The sample included 12 teenagers who
had been hospitalized for attempting suicide (SA) (31.6%); this group had a mean
age of 16.01 (SD 1.27) and comprised mostly girls (n8, 66.7%). Seven adolescents
(18.4%) were hospitalized because of severe suicidal thoughts. This suicidal
ideation group (SI) included two girls (28.6%) and ve boys (71.4%), with a mean
age of 15.25 (SD 1.85). The psychiatric control group (PC) comprised 19 adoles-
cents (50.0%) suffering from other psychiatric symptoms (depression, psychotic
crisis episodes, anorexia, etc.). They had not shown any suicidal tendencies during
their current illness. This group had a mean age of 15.59 years (SD 1.39) and
consisted of 13 girls and 6 boys (68.4% and 31.6% respectively). Between these three
groups of patients (SA, SI and PC), there was no signicant difference in age
(F(2,35) 0.65, p ns) or sex (Fisher exact test, p ns).
All participants answered a set of anonymous self-report questionnaires at
admission or after improvement in their psychiatric crisis episode. Groups were
formed according to the DSM-IV-TR diagnostic elements which had led to
hospitalization. These diagnoses were established by psychiatrists who provided
this information anonymously.
Instruments: In addition to the SIQ ( 0.96), patients completed measures of
specic psychological constructs using the following self-report questionnaires:
Self-Esteem Inventory (SEI) (Coopersmith, 1984; Coopersmith, 1987): The ver-
sion (school form) described previously was used ( 0.78).
The General Health Questionnaire (GHQ 28) (Goldberg, 1978; Pariente et al.,
1992): The GHQ 28 consists of four 7-item scales: (1) somatic symptoms, (2) anxiety
and insomnia, (3) social dysfunction, and (4) severe depression. The patient is
asked to assess changes in his/her mood, feelings, and behaviors in the previous
4 weeks, evaluated on a 4-point Likert scale: less than usual, no more than usual,
rather more than usual, and much more than usual. The total of each scale
provides four scores, a high score indicating psychological distress. GHQ 28 is
reliable ( 0.93) and has been adapted for use with psychiatric patients (Pariente
et al., 1992) and for adolescents/young adults (Werneke et al., 2000).
2.3.3. Results
Analysis using Spearman correlations revealed strong and highly signicant
correlations between the SIQ score and its associated psychological domains in the
total clinical population (Table 4). In our psychiatric sample, correlations of the SIQ
with self-esteem and psychiatric morbidity measures, particularly depression,
ranged from  0.38 to 0.74.
To determine the convergent validity of the SIQ in a clinical population, a
(3 groups  sex) ANOVA was conducted on the total SIQ score; means and standard
deviations are presented in Table 5. Contrasted group validity was investigated by
comparing the SIQ scores of attempters (SA), ideators (SI) and controls (PC), with
planned comparisons indicating signicant differences between groups. More
precisely, the psychiatric control group was compared with adolescents presenting
suicidal problems (attempters and ideators), and attempters were compared with
ideators. SIQ scores were signicantly higher among attempters and ideators than
among other psychiatric patients.
Finally, we examined the clinical usefulness of cutoff scores to differentiate
suicidal adolescents from psychiatric controls. According to Reynolds, adolescents
474 C. Potard et al. / Psychiatry Research 215 (2014) 471476

Table 4 Table 7
Correlations between the SIQ and related con- Internal consistency and test-retest correlations for the SIQ (Spearman
structs in a psychiatric sample (r de Spearman). correlations).

SIQ Cronbach's Alpha Cronbach's Alpha Test-retest

Time 1 Time 2 correlations
Self-esteem
General self-esteem  0.53nnn Suicidal Ideation 0.95 0.96 0.91n
Social self-esteem ns Questionnaire
Family self-esteem  0.38n
n
Academic self-esteem  0.44nn p o 0.001.

General health
Somatic symptoms 0.46nn the statistical analysis. There was no difference between this group and the rest of
Anxiety/insomnia 0.42n the participants in terms of gender (t(97)  0.85, p 0.398) and initial SIQ scores
Social dysfunction 0.49nn (2 0.99, p 0.320).The nal sample (n 56) consisted of 46 girls (82.1%) and 10
Several depression 0.74nnn boys (17.9%), with a mean age of 18.36 (SD 0.62). There was no signicant age
difference between boys and girls (t(54)  0.76, p 0.45). For both tests, the SIQ
ns: Non-signicant. was administered online after an initial invitation sent by e-mail. Students had to
n choose the same nickname on both tests. No class incentive was offered.
p o 0.05.
nn Instruments: All participants completed the SIQ version described above.
p o 0.01.
nnn
p o 0.001.
2.4.3. Results
To verify the test-retest reliability of the SIQ, correlations between scores for
Table 5 Time 1 and Time 2 were calculated. In addition, the internal consistency of the
Comparisons of mean and standard deviation for SIQ for the suicidal attempters scales was compared using Cronbach's alpha values for each testing session. Results
group, the suicidal ideators group and the psychiatric control group. are presented in Table 7. ShapiroWilk's test revealed that scores for T1 and T2
were not normally distributed (T1: W 0.87, p o 0.001; T2: W 0.82, p o 0.001),
Suicidal Suicidal Psychiatric F p Planned comparisons and nor was the residual analysis of the test-retest correlation W 0.87, po 0.001.
attempters ideation (SI) control (PC) Non-parametric tests were therefore used to assess the test-retest reliability and
(SA) the differences between SIQ scores over time. The SIQ displayed adequate test-
retest correlation (Spearman's correlation) r 0.91. Internal consistency values
M SD M SD M SD ranged between 0.95 and 0.96 and were thus deemed satisfactory, at both Time
n
1 and Time 2. The SIQ had excellent reliability (0.91) with Cronbach's alpha
SIQ 96.65 25.49 93.81 65.94 53.73 45.56 4.14 SA & SI 4PC above 0.70.

ns: Non-signicant.
nn
p o 0.01.
n
po 0.05. 3. Discussion

Suicidal thoughts in adolescence are common but can be

Table 6
worrying. France is particularly concerned by suicide among
Cutoff scores on the Suicidal Ideation Questionnaire (attempter vs. control group).
young people but has no reliable preventive instruments. The
Cutoff Sensitivity Specicity PPV NPV Correct classication objective of this study was to validate the French version of the SIQ
to remedy this gap. To this end, the psychometric properties of the
20 0.88 0.30 0.37 0.83 0.48 SIQ were tested on a population of French teenagers and young
30 0.88 0.30 0.37 0.83 0.48
41 0.88 0.47 0.43 0.88 0.60
adults, including general and psychiatric subjects. Overall, the
results of these three studies demonstrate that the SIQ has
PPV Positive Predictive Value and NPV Negative Predictive Value. acceptable levels of reliability and validity in a sample of French
adolescents.
with scores at or above 41 on the SIQ should be referred for further evaluation of
In this study, we opted for a one-factor model as the three-
potentially signicant psychopathology and suicide risk (Reynolds, 1988, pp.
1011). Table 6 presents the sensitivity, specicity, positive predictive value, and factor model provided only a slight improvement. Moreover,
negative predictive value of the SIQ, based on the standards of Kessel and preliminary work by Reynolds (1988, 1989), Pinto et al. (1997)
Zimmerman (1993): (a) sensitivity is the proportion of correctly identied suicide and Cassidy and Cross (2000) suggests that the factor structure of
attempters; (b) specicity is the proportion of psychiatric controls correctly
the SIQ could be described best by a one-dimensional model
identied as not being suicide attempters; (c) positive predictive value (PPV) is
the proportion of individuals classied as suicidal and who were actually suicide
(exploratory analysis). Principal components factor analyses
attempters; and (d) negative predictive value (NPV) is the proportion of patients revealed correlated factors with a strong principal factor in each
correctly predicted as non-suicide attempters. study. Our conrmatory factor analysis indicates that the one-
As shown in Table 6, we found that the cutoff score of 41 recommended by factor model has a moderately good t for an adolescent sample
Reynolds (1989) produced good sensitivity in this psychiatric inpatient sample (88%
(1418 years old). In terms of internal validity, model t indices
of actual attempters were identied as suicide attempters) and moderate specicity
(47% of non-attempters were identied as such). More liberal cutoffs were tested showed that the goodness-of-t of the SIQ one-factor model was
but did not improve the specicity. lower than conventional recommended standards, although still
adequate.
2.4. Study 3 As expected, self-esteem, suicidal ideation, and general risk to
health were signicantly correlated within the total sample. These
2.4.1. Objective results are in line with several studies investigating links between
The purpose of this study was to examine the test-retest reliability of the SIQ. suicidal ideation, depression and other related constructs (neuro-
A sample of university students completed the SIQ twice, with an interval of
ticism, anxiety, etc.) (Velting, 1999; Huth-Bocks et al., 2007;
2 weeks.
Jacobson et al., 2010). However, the signicant relationship
between depression and suicidal ideation in our sample is note-
2.4.2. Method
Participants and procedure: Data were collected from 100 rst-year university
worthy. This result is similar to those of Reynolds (1988) and
students (Franois Rabelais University, Tours, France) aged 17 to under 19 years. Mazza and Reynolds (1998) who found moderate to strong
Forty-four students did not complete the retest phase and were eliminated from correlations between the severity of depressive symptoms and
 C. Potard et al. / Psychiatry Research 215 (2014) 471476
the SIQ. In general, correlations between the SIQ and the related
psychological constructs provide a pattern of results supporting
satisfactory convergent validity.
The purpose of the second study was to evaluate the conver-
gent validity of the French version of the SIQ using a psychiatric
sample of adolescents. The results are consistent with those of
Pinto et al. (1997), indicating that the psychiatric control group
had signicantly lower scores on the SIQ than the suicide-related
groups (attempters and ideators). However, there was no signi-
cant difference between the two suicide-related groups. This result
is identical to that of Pinto et al. (1997), who used the same group
typology with American Indian teenagers. This absence of differ-
ence indicates that suicide attempters do not necessarily present
more critical suicidal ideation than ideators. Pinto and collabora-
tors also considered the hypothesis that attempters may experi-
ence some cathartic relief in ideation as a sequela of engaging in a
suicidal action (Pinto et al., 1997, p. 64). However, our result could
also be the consequence of a small sample, making the SIQ means
unstable.
In our adolescent psychiatric patients, self-reported ideation on
the SIQ relates to the ratings of clinicians on suicidal ideation and
past suicide attempts. These results are in line with those of
Prinstein et al. (2001) using another self-report Suicidal Ideation
Questionnaire. Indeed, many studies have demonstrated strong
links between suicidality (suicidal ideation, threats, and/or
attempts) and psychological disturbance (depressive symptoms,
low self-esteem, etc.) (Spirito et al., 2003; Sarchiapone et al., 2012).
In our clinical sample, SIQ scores were substantially linked with
low self-esteem, depression, anxiety and social dysfunction.
Reynolds (1989) proposed that an SIQ cutoff score of 41 suggests
the need for further suicidal screening. We found that this cutoff
score produced good sensitivity and moderate specicity in this
psychiatric inpatient sample but failed to identify 12% of the
suicide attempters. It has been established that the SIQ has 83
100% sensitivity and 4070% specicity (Cooper et al., 2011).
Nevertheless, these results of contrasted group validity should be
viewed as preliminary and future research with additional criteria
is warranted.
Regarding reliability, the results indicate that the SIQ has a high
level of internal consistency and satisfactory test-retest reliability
over a 2-week period, in line with the ndings of Reynolds (1991),
Pinto et al. (1997) and Mazza and Reynolds (1998). Although the
results are powerful and little difference has been found between
paper and on-line measures for psychological research (Riva et al.,
2003), it should be emphasized that the sample of study 3 (test-
retest) was small, thereby limiting statistical power and increasing
the likelihood of a Type II error. Several limitations regarding the
generalizability of this study should be highlighted. Future
research with larger samples is clearly needed. Future studies on
the temporal stability of the SIQ should include a broader sample
of adolescents (and not a college sample). Moreover, the stability
of scores should be assessed over a 6-month period.
The relevance of using the SIQ in research and clinical practice
depends on the t between its psychometric qualities and its
practical use. Several studies suggest that self-report measures
identify adolescents at risk for suicidality as efciently as, or better
than, interviews for example (Prinstein et al., 2001). Self-report
measures are also of value for health professionals because they
can be completed, scored, and interpreted rapidly. This study
established that the SIQ has good reliability, sensitivity and
validity in a population of French adolescents. The test-retest also
showed that it has good internal consistency. Furthermore, as the
underlying basis of the SIQ is a single factor structure with an
overall score, it can be used to determine the severity of suicidal
ideation among French adolescents. Together with the results of
other studies conducted with the SIQ (Reynolds, 1988; Keane et al.,
475
1996; Pinto et al., 1997; Abdel-Khalek and Lester, 2007), these
results demonstrate that the SIQ is versatile and can provide an
overall score indicating the severity of suicidal thoughts. However,
further research is required to assess thoroughly the psychometric
properties of the SIQ, particularly to establish its predictive validity
through prospective and longitudinal studies, and to evaluate the
intent and lethality of suicide attempts in a large sample of
psychiatric and control adolescents.
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