The Modular Assessment of Risk for Imminent Suicide (MARIS): A validation study of a novel tool for suicide risk assessment

Raffaella Calati, Lisa J. Cohen, Allison Schuck, Dorin Levy, Sarah Bloch-Elkouby, Shira Barzilay, Paul J. Rosenfield, Igor Galynker

Research output: Contribution to journalArticlepeer-review


Background: Reliable diagnostic tools for the short-term suicide risk assessment are needed. The recently developed multi-informant Modular Assessment of Risk for Imminent Suicide (MARIS) includes four modules: two are patient-rated and two clinician-rated. The patient-rated modules assess a proposed pre-suicidal cognitive/emotional state (Module 1) as well as patients’ attitudes towards suicide (Module 2). The clinician-rated modules assess traditional suicide risk factors (Module 3) and clinicians’ emotional responses to the patient (Module 4). Methods: With the aim of extending our previous preliminary proof of concept findings, the MARIS was administered to 618 psychiatric patients (167 inpatients, 451 outpatients) and their clinicians (N = 115). Patients were assessed with a battery including the Columbia-Suicide Severity Rating Scale. Four outcomes were considered: lifetime and past month suicidal thoughts and behaviors (STB) (0–10 point scale) and suicidal behaviors (SB) (0–5 point scale). Reliability and concurrent, convergent/divergent and incremental validity were assessed. Results: Good internal consistency was found for modules 1 and 4 (Cronbach's α: 0.87 and 0.86, respectively) but not for the others. Module 1′s total score positively correlated with lifetime STB/SB and past month STB (all p ≤ 0.003). Module 4′s total score positively correlated with all four outcomes (all p < 0.0001). Modules 1 and 4 showed additional capacity to detect patients’ lifetime and past month STB/SB beyond other associated factors. Limitations: Lack of prospective assessment. Inpatients were evaluated at discharge, whereas outpatients at intake. Conclusions: These findings supported the utility of multiple data sources to identify patients at imminent suicide risk, and in particular clinicians' emotional responses.

Original languageEnglish
Pages (from-to)121-128
Number of pages8
JournalJournal of Affective Disorders
StatePublished - 15 Feb 2020
Externally publishedYes

Bibliographical note

Funding Information:
This study was supported by the American Foundation for Suicide Prevention (AFSP) focus grant # RFA-1-015-14 . The content is solely the responsibility of the authors and does not necessarily represent the official AFSP views. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The authors would like to thank all the participants, patients and clinicians, and research assistants who contributed to data collection and entry.

Publisher Copyright:
© 2019


  • Assessment/diagnosis
  • Depression
  • Health services
  • Measurement/psychometrics
  • Suicide/self harm
  • Reproducibility of Results
  • Prospective Studies
  • Risk Assessment
  • Humans
  • Risk Factors
  • Psychometrics
  • Suicidal Ideation
  • Suicide Prevention
  • Suicide, Attempted

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Clinical Psychology


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