Protocol - Lethality of Suicide Attempts

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The Beck Lethality Scales includes eight items that measure the medical lethality of previous suicide attempts (e.g., shooting, jumping, and drug overdose). Each scale is rated from 0 to 10, based on an examination of the patient’s physical condition on admission, review of the medical charts, and consultation with the attending physician.

Specific Instructions

This protocol includes questions that can potentially identify respondents who are at risk of suicide. Investigators implementing this protocol should consider developing a risk management plan specific to their study to ensure the safety of participants. The following links provide additional information and guidelines for suicide-related research:







Instructions to interviewer: These scales establish the lethality of patients’ suicide attempt(s). Use all available information to establish the lethality of each previous suicide attempt.

Enter the date (MM/YY) of each suicide attempt, then code the lethality of each suicide attempt, starting with the MOST recent suicide attempt. If the patient used more than one method, code each method, beginning with the MOST lethal. (Example: on 12/1/95, a patient attempted suicide by consuming a liter of grain alcohol and a gunshot to the abdomen. This would be coded as date: 12/95; primary code 0306; secondary code 0104.)

Listing of Lethality Codes

LETH 01 Lethality Scale for Coma-Producing Drugs

00[ ]Fully conscious and alert

01[ ]Conscious but sleepy

02[ ]Lethargic-speech and motility retarded but responsive to questions; intellectual functions intact

03[ ]Lethargic with diminution in intellectual ability

04[ ]Severely blunted, dull, or lacking in vigor, but awake and somewhat responsive

05[ ]Asleep but easily aroused

06[ ]Comatose-withdrawal from painful stimuli; reflexes intact

07[ ]Comatose-no withdrawal from painful stimuli; most reflexes intact; no respiratory or circulatory depression

08[ ]Comatose-most reflexes absent; no respiratory or circulatory depression

09[ ]Comatose-all reflexes absent; respiratory depression with cyanosis or circulatory failure and shock both

10[ ]Death

99[ ]Does not apply

LETH 02 Lethality for Non-Coma-Producing Drugs

00[ ]No damage

02[ ]Minimal medical consequences or treatment

04[ ]Some injury (e.g. mouth burns) and treatment in emergency room or on out-patient basis (e.g. gastric lavage)

06[ ]Injury sufficient for hospitalization-vital signs and level of consciousness may be affected

08[ ]Major systemic effects-such as G.I. perforation, renal failure, blood hemolysis, or shock; vital signs unstable

10[ ]Death

99[ ]Does not apply

LETH 03 Lethality Scale for Shooting

00[ ]No Damage

02[ ]Flesh wounds with powder burns

04[ ]Bullet lodged in extremity-minor bleeding

06[ ]Bullet in abdomen or chest-major bleeding; vital signs unstable

08[ ]Bullet to head area

10[ ]Death

99[ ]Does not apply

LETH 04 Lethality Scale for Burning

00[ ]No damage

02[ ]First-degree burns

04[ ]Second-degree burns

06[ ]Third-degree burns under 20% body area

08[ ]Third-degree burns over 60% body area

10[ ]Death

99[ ]Does not apply

LETH 05 Lethality Scale for Drowning

00[ ]No damage

02[ ]Conscious-some respiratory distress but no resuscitation needed

04[ ]Conscious-minimal to moderate efforts at resuscitation needed

06[ ]Conscious-extensive efforts at resuscitation needed

08[ ]Unconscious-massive efforts at resuscitation necessary for revival

10[ ]Death

99[ ]Does not apply

LETH 06 Lethality Scale for Cutting

00[ ]Surface scratches; none or minor bleeding; little or no wound care required.

02[ ]Moderate bleeding with clotting before significant blood loss occurs; simple wound care required

04[ ]Bleeding of major vessel; danger of considerable blood loss without surgical intervention-suturing necessary but no transfusion; vital areas intact and no change in vital signs; care on out-patient basis

06[ ]Extensive blood loss; suturing, blood replacement and tendon repair required; wound may be to head, thorax, or abdomen but vital organs intact and vital signs stable; recovery with in-patient care expected

08[ ]Extensive blood loss with shock; insult to vital areas with change in vital signs; recovery with in-patient care doubtful

10[ ]Death

99[ ]Does not apply

LETH 07 Lethality Scale for Jumping

00[ ]Minor bruises only no treatment necessary

02[ ]Sprains or minor injuries-no bone, ligament, or tendon damage; no internal bleeding, tissue or brain damage

04[ ]Extremities fractured-casting necessary but no major tendon repair and complete recovery expected

06[ ]Major one and/or tendon damage in multiple areas-internal bleeding; some residual impairment expected but not in vital areas

08[ ]Major damage to vital area (skull, neck, spinal column); paralysis expected

10[ ]Death

99[ ]Does not apply

LETH 08 Lethality Scale for Hanging

00[ ]No damage

02[ ]Simple rope burns

04[ ]More extensive injuries with treatment on out-patient basis

06[ ]Hospitalization and resuscitation required

08[ ]Paralysis or other spinal cord injury

10[ ]Death

99[ ]Does not apply

Personnel and Training Required

The interviewer must be trained to conduct personal interviews with individuals from the general population. The interviewer must be trained and found to be competent (i.e., tested by an expert) at the completion of personal interviews. The interviewer should be trained to prompt respondents further if a "don’t know" response is provided.

Equipment Needs

The PhenX Working Group acknowledges these questions can be administered in a computerized or noncomputerized format (i.e., paper-and-pencil instrument). Computer software is necessary to develop computer-assisted instruments. The interviewer will require a laptop computer/handheld computer to administer a computer-assisted questionnaire.

Requirement CategoryRequired
Major equipment No
Specialized training No
Specialized requirements for biospecimen collection No
Average time of greater than 15 minutes in an unaffected individual No
Mode of Administration

Interviewer-administered questionnaire


Adolescent, Adult


Adolescents and adults, ages 12 and older

Selection Rationale

The Beck Lethality Scales are generally accepted by researchers and have demonstrated interrater reliability and convergent validity.



Human Phenotype Ontology Suicidal Ideation HP:0031589 HPO
caDSR Form PhenX PX640401 - Lethality Of Suicide Attempts 6232996 caDSR Form
Derived Variables


Process and Review

Not applicable.

Protocol Name from Source

The Beck Lethality Scales


Beck, A. T., Beck, R., & Kovacs, M. (1975). Classification of suicidal behaviors: I. Quantifying intent and medical lethality. American Journal of Psychiatry, 132(3), 285-287.

General References

Lester, D., & Beck, A. T. (1975). Attempted suicide: Correlates of increasing medical lethality. Psychological Reports, 37(3 PT 2), 1236-1238.

Spokas, M., Wenzel, A., Brown, G. K., & Beck, A. T. (2012). Characteristics of individuals who make impulsive suicide attempts. Journal of Affective Disorders 136(3), 1121-1125.

Weissman, A. D., & Worden, J. W. (1986). Risk-rescue rating in suicide assessment. In A. T. Beck, H. L. P. Resnik, & D. J. Lettieri (Eds). The prediction of suicide (2nd ed., pp. 193-213). Philadelphia: Charles Press.

Protocol ID


Export Variables
Variable Name Variable IDVariable DescriptiondbGaP Mapping
PX640401010000 Month of suicide attempt 1 (most recent) N/A
PX640401030000 Suicide attempt 1, first suicide lethality more
code (Most Lethal) show less
PX640401040000 Suicide attempt 1, second suicide lethality code N/A
PX640401050000 Suicide attempt 1, third suicide lethality code N/A
PX640401020000 Year of suicide attempt 1 (most recent) N/A
PX640401060000 Month of suicide attempt 2 N/A
PX640401080000 Suicide attempt 2, first suicide lethality more
code (Most Lethal) show less
PX640401090000 Suicide attempt 2, second suicide lethality code N/A
PX640401100000 Suicide attempt 2, third suicide lethality code N/A
PX640401070000 Year of suicide attempt 2 N/A
PX640401110000 Month of suicide attempt 3 N/A
PX640401130000 Suicide attempt 3, first suicide lethality more
code (Most Lethal) show less
PX640401140000 Suicide attempt 3, second suicide lethality code N/A
PX640401150000 Suicide attempt 3, third suicide lethality code N/A
PX640401120000 Year of suicide attempt 3 N/A
PX640401160000 Month of suicide attempt 4 N/A
PX640401180000 Suicide attempt 4, first suicide lethality more
code (Most Lethal) show less
PX640401190000 Suicide attempt 4, second suicide lethality code N/A
PX640401200000 Suicide attempt 4, third suicide lethality code N/A
PX640401170000 Year of suicide attempt 4 N/A
PX640401210000 Month of suicide attempt 5 N/A
PX640401230000 Suicide attempt 5, first suicide lethality more
code (Most Lethal) show less
PX640401240000 Suicide attempt 5, second suicide lethality code N/A
PX640401250000 Suicide attempt 5, third suicide lethality code N/A
PX640401220000 Year of suicide attempt 5 (most recent) N/A
Measure Name

Lethality of Suicide Attempts

Release Date

November 21, 2014


A rating scale to assess the degree of medical lethality of a suicide attempt.


Previous suicide attempts of high lethality are associated with increased future suicide risk and a greater determination to die.


suicide, Suicide attempts, Self-injury, Lethality

Measure Protocols
Protocol ID Protocol Name
640401 Lethality of Suicide Attempts

Goodman, M., et al. (2020) Group (?Project Life Force?) versus individual suicide safety planning: A randomized clinical trial. Contemporary Clinical Trials Communications. 2020 January; 17: 100520. doi: 10.1016/j.conctc.2020.100520

Bryan, C. J., et al. (2019) The PRImary care Screening Methods (PRISM) study: Rationale and design considerations. Contemporary Clinical Trials. 2019 September; 84: 105823. doi: 10.1016/j.cct.2019.105823