The Living Ladder: Introduction and Validity Over 6-Month Follow-Up of a One-Item Measure of Readiness to Continue Living in Suicidal Patients

Objective: The ability to predict suicide outcomes is limited by the lack of consideration of protective factors. This study examined the validity of the Living Ladder, a measure of readiness to continue living among individuals thinking of suicide. Methods: The Living Ladder consists of one item that assesses an individual’s readiness to continue living when thinking about suicide. Participants (N = 130) completed the Living Ladder in-person at baseline and by-phone at 1-, 3-, and 6-month follow-up. The prospective association of the Living Ladder with suicidal ideation and risk for a suicide attempt was examined using models adjusting for baseline ideation and suicide attempts, respectively. Results: Each rung on the Living Ladder was associated with 18% lower likelihood of suicidal ideation, OR (95% CI) = 0.82 (0.68, 0.96), and less severe suicidal ideation among those with ideation. Scores >2, indicating contemplation of living, were associated with 64% lower risk for a suicide attempt, HR (95% CI) = 0.36 (0.13, 0.98). Findings for suicidal ideation were replicated when administered by-phone. Conclusions: The Living Ladder is a one-item measure that is prospectively associated with suicidal ideation and suicide attempts. Findings support the relevance of motivation to live to suicide outcomes.