The Suicidal Behaviors Questionnaire-Revised (SBQ-R) is a four-item self-report screen that samples four distinct domains of suicide risk: lifetime suicidal ideation and attempts (item 1), frequency of ideation over the past twelve months (item 2), lifetime communication of suicidal intent to others (item 3), and self-rated likelihood of a future attempt (item 4). Item scores sum to a total of 3-18, with higher totals indicating greater risk.
Unlike single-timeframe measures, the SBQ-R deliberately mixes historical and prospective perspectives - past behaviour, recent ideation, disclosure, and self-predicted future risk - because each domain carries independent information about risk. It is a screening aid that flags who needs a fuller clinical risk assessment; it is not a risk-prediction instrument and no score rules risk out.
02 - Origin & purpose
Where it comes from.
The SBQ-R was published by Augustine Osman and colleagues in 2001 as a revision of Marsha Linehan's earlier, longer Suicidal Behaviors Questionnaire, retaining the four most informative items. It was validated in four samples spanning clinical and non-clinical, adolescent and adult populations: psychiatric inpatient adolescents, high-school students, psychiatric inpatient adults, and undergraduates.
The intent was a screen brief enough for routine intake in mental-health and research settings while still covering behaviour, ideation, communication and future orientation. A systematic review of nineteen self-report measures of suicide-related thoughts and behaviours later ranked it among the top three against six psychometric criteria, including being free to use (Batterham et al., 2015).
03 - Scoring & cutoffs
How scoring works.
The four items are summed to give a total of 3-18. Item 1 scores 1-4, with the response options describing a plan and an attempt collapsing onto shared values; item 2 scores 1-5; item 3 scores 1-3; and item 4 scores 0-6.
The validated cutoff is 7 or above for adults in the general population and 8 or above for adult psychiatric inpatients (Osman et al., 2001). Scores at or above the relevant cutoff warrant a fuller clinical risk assessment. Any endorsement of recent ideation, a plan, or a past attempt merits direct clinical follow-up regardless of the total.
Score
Severity
Interpretation
3–6
Below screening threshold
In the general adult population, scores below 7 fall under the validated cutoff.
7–7
At or above the general-population cutoff
At or above the validated cutoff of 7 or more for adults in the general population (sensitivity 93%, specificity 95%; Osman et al., 2001). Warrants fuller clinical risk assessment.
8–18
At or above the clinical cutoff
At or above the validated cutoff of 8 or more for adult psychiatric inpatients (sensitivity 80%, specificity 91%), and above the general-population cutoff of 7. Warrants fuller clinical risk assessment.
This content is intended for use by healthcare professionals and is not a self-diagnosis or risk-prediction tool. If you or someone you know is in immediate danger, contact emergency services (999 in the UK, 112 in the EU) or a crisis line such as the Samaritans on 116 123. A score never replaces a clinical risk assessment and safety planning conversation.
04 - Validation evidence
How well it performs.
In the original validation, ROC analyses identified a total of 7 or above as the most useful cutoff in non-clinical adult samples (sensitivity 93%, specificity 95%) and 8 or above in clinical samples (sensitivity 80%, specificity 91%).
Internal consistency has been consistently adequate to excellent across international validations, with Cronbach's alpha values from roughly 0.80 (Nigerian university students; Aloba et al.) to 0.91 (Iranian validation; Amini-Tehrani et al.).
Batterham and colleagues' 2015 systematic review of nineteen measures ranked the SBQ-R among the top three self-report instruments across internal consistency, test-retest reliability, construct validity, concurrent validity, sensitivity to change and cost criteria.
93%
SENSITIVITY (≥7)
General adult population (Osman et al., 2001)
95%
SPECIFICITY (≥7)
General adult population (Osman et al., 2001)
80% / 91%
SENS / SPEC (≥8)
Adult psychiatric inpatients (Osman et al., 2001)
0.80–0.91
CRONBACH'S α
Internal consistency across international validations
05 - How it compares
How it compares to the alternatives.
Instrument
Items
Time
When to reach for it
SBQ-R
4
~1 min
Brief adult screen giving a graded 3-18 total across history, recent ideation, disclosure and self-predicted risk.
Passive ideation flag inside a depression measure; a positive answer needs a dedicated follow-up screen.
BSS
21
~10 min
Beck Scale for Suicide Ideation. Licensed (Pearson); quantifies current ideation intensity rather than screening.
DSI-SS
4
~1 min
Free ideation-focused subscale suited to population research.
06 - When to use it
Right tool, wrong tool.
In the comparison above, instruments without a page link are not yet in the Aisel library.
The SBQ-R earns its place at intake: it is quick, free, and covers ground a single-timeframe screen misses. It is a poor choice wherever a changing quantity needs measuring.
Reach for it when
-Routine intake screening in adult mental-health services.
-Research requiring a brief, free, validated total score.
-Capturing history, disclosure and self-predicted risk alongside current ideation.
-Settings where a self-report complement to the clinical interview is wanted.
Reach for something else when
-Monitoring treatment response - three of four items are lifetime or trait-like, so totals barely move.
-Standalone risk formulation or prediction of imminent behaviour.
-Autistic adults without adaptation - measurement work suggests wording and response options perform poorly (Cassidy et al., 2020).
-Children - validation begins at adolescence.
07 - Confidence & precision
Reading the score with care.
No standard error of measurement or minimal clinically important difference has been established for the SBQ-R, and its mixed lifetime and recent structure means the total is largely stable by construction. Precision is therefore best expressed through its screening operating characteristics at the validated cutoffs: 93% sensitivity and 95% specificity at 7 or above in the general population, and 80% sensitivity and 91% specificity at 8 or above in inpatient settings.
Treat the score as a triage signal rather than a measurement of a changing quantity, and treat item-level endorsements - a plan, an attempt, a high self-rated likelihood - as clinically actionable regardless of the total.
08 - Limitations
What it cannot tell you.
Mixed timeframes and inconsistent response formats across the four items complicate interpretation and psychometric modelling, and item 1 collapses plans and attempts into shared score values. The total is insensitive to change, so it cannot track treatment response, and unidimensionality remains contested.
Language and response options perform poorly in autistic adults. As with all suicide screens, the SBQ-R identifies elevated-risk groups; it does not predict individual behaviour, and a low score never overrides clinical concern.
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