The Rorschach suicide constellation: Assessing various degrees of lethality

In this article we examine the relation between the Rorschach Comprehensive System's Suicide Constellation (S-CON; Exner, 1993; Exner & Wiley, 1977) a nd lethality of suicide attempts during the course of patients' hospitaliza tion at the Austen Riggs Center (Stockbridge, MA). Patient records were rat ed as nonsuicidal (n = 37), parasuicidal (n = 37), or near-lethal (n = 30) based on the presence and lethality of self-destructive acts. Diagnostic ef ficiency statistics utilizing a cutoff score of 7 or more positive indicato rs successfully predicted which patients would engage in near-lethal suicid al activity relative to parasuicidal patients (overall correct classificati on rate [OCC] = .79), nonsuicidal inpatients (OCC = .79), and college stude nts (OCC = .89). Although these predictions were influenced by relatively h igh base rates in the hospital population (14.5%), base rate estimates were calculated for other hypothetical populations revealing different predicti on estimates that should be considered when judging the relative efficacy o f the S-CON. Logistic regression analysis revealed that an S-CON score of 7 or more was the sole predictor of near-lethal suicide attempts among 9 psy chiatric and demographic variables.