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.



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

Protocol Name from Source:

This section will be completed when reviewed by an Expert Review Panel.


Publicly available

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

Life Stage:

Adolescent, Adult


Adolescents and adults, ages 12 and older

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:



Selection Rationale

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



Common Data Elements (CDE) Beck Lethality Scale Assessment 4588804 CDE Browser
Derived Variables


Process and Review

This section will be completed when reviewed by an Expert Review Panel.


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 NameVariable IDVariable DescriptionVersiondbGaP Mapping
PX640401_Suicide_Attempt1_Month PX640401010000 Month of suicide attempt 1 (most recent) 4 N/A
PX640401_Suicide_Attempt1_Primary_Lethality_Code PX640401030000 Suicide attempt 1, first suicide lethality code (Most Lethal) 4 N/A
PX640401_Suicide_Attempt1_Secondary_Lethality_Code PX640401040000 Suicide attempt 1, second suicide lethality code 4 N/A
PX640401_Suicide_Attempt1_Tertiary_Lethality_Code PX640401050000 Suicide attempt 1, third suicide lethality code 4 N/A
PX640401_Suicide_Attempt1_Year PX640401020000 Year of suicide attempt 1 (most recent) 4 N/A
PX640401_Suicide_Attempt2_Month PX640401060000 Month of suicide attempt 2 4 N/A
PX640401_Suicide_Attempt2_Primary_Lethality_Code PX640401080000 Suicide attempt 2, first suicide lethality code (Most Lethal) 4 N/A
PX640401_Suicide_Attempt2_Secondary_Lethality_Code PX640401090000 Suicide attempt 2, second suicide lethality code 4 N/A
PX640401_Suicide_Attempt2_Tertiary_Lethality_Code PX640401100000 Suicide attempt 2, third suicide lethality code 4 N/A
PX640401_Suicide_Attempt2_Year PX640401070000 Year of suicide attempt 2 4 N/A
PX640401_Suicide_Attempt3_Month PX640401110000 Month of suicide attempt 3 4 N/A
PX640401_Suicide_Attempt3_Primary_Lethality_Code PX640401130000 Suicide attempt 3, first suicide lethality code (Most Lethal) 4 N/A
PX640401_Suicide_Attempt3_Secondary_Lethality_Code PX640401140000 Suicide attempt 3, second suicide lethality code 4 N/A
PX640401_Suicide_Attempt3_Tertiary_Lethality_Code PX640401150000 Suicide attempt 3, third suicide lethality code 4 N/A
PX640401_Suicide_Attempt3_Year PX640401120000 Year of suicide attempt 3 4 N/A
PX640401_Suicide_Attempt4_Month PX640401160000 Month of suicide attempt 4 4 N/A
PX640401_Suicide_Attempt4_Primary_Lethality_Code PX640401180000 Suicide attempt 4, first suicide lethality code (Most Lethal) 4 N/A
PX640401_Suicide_Attempt4_Secondary_Lethality_Code PX640401190000 Suicide attempt 4, second suicide lethality code 4 N/A
PX640401_Suicide_Attempt4_Tertiary_Lethality_Code PX640401200000 Suicide attempt 4, third suicide lethality code 4 N/A
PX640401_Suicide_Attempt4_Year PX640401170000 Year of suicide attempt 4 4 N/A
PX640401_Suicide_Attempt5_Month PX640401210000 Month of suicide attempt 5 4 N/A
PX640401_Suicide_Attempt5_Primary_Lethality_Code PX640401230000 Suicide attempt 5, first suicide lethality code (Most Lethal) 4 N/A
PX640401_Suicide_Attempt5_Secondary_Lethality_Code PX640401240000 Suicide attempt 5, second suicide lethality code 4 N/A
PX640401_Suicide_Attempt5_Tertiary_Lethality_Code PX640401250000 Suicide attempt 5, third suicide lethality code 4 N/A
PX640401_Suicide_Attempt5_Year PX640401220000 Year of suicide attempt 5 (most recent) 4 N/A
Research Domain Information
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