Suicide Assessment Kit-Modified Interview
(SAK-MI) Diagnostic Tool
This tool generates an estimate score and category based on the SAK-MI coding algorithm.
Before commencing
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Explain the purpose of the assessment.
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Emphasise that the questions are intended to support understanding and safety.
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Provide the visual analogue response scales and explain how they are used. These are optional and not required to complete the SAK-MI. Always ask the individual about their preferences.
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Allow additional processing time as needed.
The interview should be conducted using concrete, unambiguous language, with response exemplars and definitions used where helpful. Professionals should check understanding throughout and adapt pacing as required. While it is developed to be completed in one sitting, it may be helpful to offer respondents breaks, or to pause or stop the assessment, particularly if they become agitated or distressed.
Note: All required questions are marked with an asterisk*
Question 1*
Think about the last 4 weeks. Did you feel so sad that nothing could cheer you up or make you happy?
Sad: feeling down, unhappy
Question 2*
Think about the last 4 weeks. How often did you feel that something was going to happen that would make you happy?*
*reverse score due to re-phrasing of question from original
Question 3*
Think about the last 4 weeks. How often did you feel intense shame or guilt?
Shame: a feeling that people have when they have done, said or thought things that made them feel bad or upset.
Guilt: when someone thinks they have done something wrong, and they feel bad about it.
Question 4*
In the past 4 weeks, how often did you feel worthless?
Worthless: something that has no value. When someone feels useless or like they have no value
Question 5*
Have you ever tried to kill yourself?
Question 5a*
How many times have you tried to kill yourself?
Question 5b*
How long ago did you last try to kill yourself?
Question 6*
Is something bad that happened to you still making you feel bad now?
Question 6a*
Are any of these areas of your life still making you feel bad? Please select any areas which might be making you feel bad.
Breaking up with a partner, parents getting divorced, siblings moving away
Having regular arguments with your partner, having regular arguments with your family members, communication problems with your family/partner
Someone you love has died
Sexual orientation: Includes gay/lesbian, bisexual, asexual, polyamorous, and others
Gender identity: The gender you feel you are inside which might not be the same as the gender you are on the outside. Or you might not feel like either a boy or a girl.
Being in trouble with the police or needing to go to court
Child custody: Being able to see your children
Chronic: illness and pain that lasts for a long time and needs to be managed
A very strong shock or very upsetting experience
Bullying: Teasing, hurting or being mean to someone
Question 7*
Question 7a*
In the past 4 weeks, how often have you had thoughts of killing yourself?
Question 7b*
Think about how long you have been having thoughts about killing yourself. For example, think whether you have only had thoughts about killing yourself in the past 4 weeks, or if you have had thoughts like these before.
How long have you been thinking about killing yourself?
Question 7c*
How strong are thoughts about killing yourself?
?
Not strong at all
Somewhat strong
Strong
Very strong
Don't know
Choose this answer if you don’t think about killing yourself much
Choose this answer if thoughts about killing yourself happen some of the time and are upsetting
Choose this answer if thoughts about killing yourself happen often or make you feel serious about killing yourself
Choose this answer if you think about killing yourself a lot and you have trouble thinking about anything else
Question 7d*
How strong have these thoughts of killing yourself been in the last week?
?
Not strong at all
Somewhat strong
Strong
Very strong
Don't know
Choose this answer if you don’t think about killing yourself much
Choose this answer if thoughts about killing yourself happen some of the time and are upsetting
Choose this answer if thoughts about killing yourself happen often or make you feel serious about killing yourself
Choose this answer if you think about killing yourself a lot and you have trouble thinking about anything else
Question 8*
Do you have a plan for how you would attempt to kill yourself?
*
Question 8a (i)
What is your plan to kill yourself?
Is the subject of this assessment willing to disclose details relating to this question?
Question 8a (ii)*
Are you able to access or get the things you need to carry out your plan of killing yourself?
Question 8b (i)
Where would you attempt to kill yourself?
Is the subject of this assessment willing to disclose details relating to this question?
Question 8b (ii)*
Have you finished making all the necessary preparations to carry out your plan to kill yourself?
Preparations: having things ready
Question 8c*
How likely are you to act on this plan to kill yourself?
?
Very unlikely
Unlikely
Likely
Very likely
Don't know
Question 9
What has stopped you acting on your suicidal thoughts?
Examples:
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Thinking about who will take care of your pet.
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Thinking about things you enjoy doing that you wouldn’t be able to do.
Is the subject of this assessment willing to disclose details relating to this question?
Question 10*
Do you have one person, or a few people who you can go to if you need help?
Examples of people who could help or support you:
Question 10a*
Who is/are this/these person/people?
Question 10b*
How often are you in contact with this/these person/people?
Question 11
What helps you when things are difficult or when you are feeling down, sad or depressed?
Examples:
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Sometimes when people feel sad, or when things are difficult, they may find it helpful to talk to their pet.
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Some people may make time to play an online game, or go for a walk.
Is the subject of this assessment willing to disclose details relating to this question?
Please complete the fields marked with *
Negative Affect Score (Items 1-4)
Helvetica Light is an easy-to-read font, with tall and narrow letters, that works well on almost every site.
Negative Affect Assessment
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Estimated Category
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Helvetica Light is an easy-to-read font, with tall and narrow letters, that works well on almost every site.
Recommended actions
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CAUTION: the above recommendations are a calculated estimate based on numeric evaluation of user input. To ensure sufficient accuracy of categoratisation, please refer to the coding algorithm below, particularly when assessing qualitative responses.
SAK-MI Coding Algorithm
Category/Description
Coding
Suggested action
NEGATIVE AFFECT
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Sum first four items (0-4 scale for each item, total of 16 points)
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Scores between 6-9 indicate possible depression (high sensitivity), 10+ indicate likely depression (high specificity)
Monitor, assess for possible depression
CATEGORY 1
History of suicidality absent, current stressors absent, ideation absent, support networks present, may have elevated negative affect score.
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Item 5 (Lifetime attempts) = “No” AND
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Item 6 (Current stressor) = “No” OR< 3 stressors on item 6a endorsed) AND
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Item 7 (Current ideation) = “No” AND
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Item 10 (Support network) = “Yes” AND
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Item 11 (Coping skills) identified.
Monitor, assess for possible depression
CATEGORY 2
Current lowlevel Suicidal Ideation (SI) in the absence of plan, reason to live present, support network and coping skills identified.
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Item 5 (Lifetime attempts) = “No”* AND
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Item 6 (Current stressor) = “No” OR< 3 stressors on item 6a endorsed) AND
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Item 7 (Current ideation) = “Yes” AND
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Item 7a = “None of the time,” or “A little of the time,” AND
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Item 7c = “Not strong at all” or “Somewhat strong” AND
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Item 7d= “Not strong at all” or “Somewhat strong” AND
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Item 8 (Plan) = “No” AND
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Item 9 (Reasons to Live) identified AND
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Item 10 (Support network) = “Yes” AND
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Item 11 (Coping skills) identified.
*Also code here if respondent has a history of a remote attempt (≥ 2 years prior) in the absence of current SI or other risk factors.
Monitor, assess for possible depression. Investigate therapeutic intervention based on client preference and level of distress caused by ideation. Discuss developing a safety plan and provide resources
CATEGORY 3
Presence of Suicidal Ideation (SI) with additional risk factors, some protective factors present, support network present
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Item 7 (Current ideation) = “Yes” AND any of the following
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Item 7a = “Some of the time”
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Item 7c = “Strong” • Item 7d= “Strong”
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3 + stressors endorsed on item 6a,
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Item 8 (Plan) must be “No” (if plan, automatically high risk),
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Item 5 (Lifetime attempts) = “No” or 1 attempt at least 1 year in the past allowed in this category; past-year attempt automatically Category 4 or Category 5,
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Must still have 2/3 protective factors,
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Item 9 (Reasons to Live) identified,
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Item 10 (Support network) = “Yes”
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Item 11 (Coping skills) identified.
Monitor, assess for possible depression. Investigate therapeutic intervention based on client preference and level of distress caused by ideation. Discuss developing a safety plan and provide resources.
CATEGORY 4
Presence of Suicidal Ideation (SI), history (HX) of attempts (maybe recent or multiple past attempts), presence of plan, few protective factors, support network not identified.
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Item 7 (Current ideation) = “Yes” AND any of the following:
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Item 7a = “Most of the time” or “All of the time”
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Item 7c = “Very strong”
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Item 7d= “Very strong”
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Recent attempt within past year (item 5b) and/ or multiple past attempts (item 5a)
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Item 8 (Plan) = “Yes”
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includes detailed answers for items 8a (i) and/ or 8b (i) (specific plan and location) and/or means that are accessible at some point in the future (item 8a (ii))
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0 or 1 protective factors
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Item 9 (Reasons to Live) not identified AND
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Item 10 (Support network) = “No” AND
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Item 11 (Coping skills) not identified.
Develop a safety plan and provide crisis resources. Discuss safety if returned home, consider informing family member or other support person if there are any safety concerns.
CATEGORY 5
Presence of plan, preparations, maybe unwilling to disclose details of plan, absence of protective factors or support network, unable to identify any reason to live.
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Item 8 (Plan) = “Yes” AND any of the following
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Unwilling to disclose details of suicide plan (items 8a/b (i))
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Item 8b (finished making preparations) = “Yes”
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No protective factors
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Item 9 (Reasons to Live) not identified AND
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Item 10 (Support network) = “No” AND
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Item 11 (Coping skills) not identified
Admit to hospital. Monitor and restrict access to means.