Nurse and Peer Led Suicide Prevention in Tajikistan

Suicide attempts (measured by the Columbia Suicide Severity Rating Scale) Any suicide attempt as measured according to an electronic self-report version of the Columbia Suicide Severity Rating Scale (CSSR-S). The definition of suicide attempt for the primary outcome will consist of any actual suicide attempt, aborted suicide attempt, or interrupted suicide attempt according to the CSSR-S.

Medical record data on suicide attempts will be collected when a participant reports receiving care at an Emergency Room or hospital for reasons related on mental health or substance abuse on the Heath Services Inventory (HIS) at the 3, 6, and 9 month outcome assessments, or when a participant reports seeking medical attention for suicidal behavior during the Columbia Suicide Severity Rating Scale at the 3, 6, and 9 month outcome assessments. Whenever a participant reports received medical attention on these measures, study staff will ask the participant to provide the name of the treating facility. Before the follow-up visit is completed, the participant will be asked to sign a Request for Outside Records, allowing study staff to request medical records from any facility outside of study performance sites. Signing this form is voluntary. If a participant chooses not to sign a form, the participant's self-report will be used to measure medically serious suicide attempts.

A tool designed to measure intense feelings of hopelessness, unlovability, and inability to cope, often associated with chronic suicide risk.

B-SCS employs Likert-scaling (1-5) and scores are calculated by summing the keyed responses and yields a score between 6 and 30

The Beck Hopelessness Scale (BHS) is a 20-item, true/false self-report inventory designed to measure an individual's negative expectations and pessimism about the future, with higher scores indicating greater hopelessness. It assesses feelings about the future, loss of motivation, and future expectations, with total scores ranging from 0-20.

The BRFL is a 12-item self-report measure intended to assess adaptive beliefs and expectations for living. The inventory has six subscales: fear of suicide, responsibility to family, survival and coping beliefs, child-related concerns, moral objections, and fear of social disapproval. The 12 items are scored on a 6-point scale ranging from (1) "not at all important" to (6) "extremely important". Higher scores on the BRFL scale and on its subscales reflect more reasons for living.

The PHQ-9 is a 9-question, self-report tool used to screen, diagnose, and monitor depression severity by measuring symptom frequency over the past two weeks. It uses a 4-point Likert scale (0-3), with total scores ranging from 0 to 27. Higher scores indicate greater severity (5-9: Mild, 10-14: Moderate, 15-19: Moderately severe, 20-27: Severe).

The Generalized Anxiety Disorder-7 (GAD-7) is a validated, 7-item self-report questionnaire designed to screen for and measure the severity of generalized anxiety disorder in the past two weeks. Items are scored 0-3, totaling 0-21, with higher scores indicating greater anxiety severity. Scores greater than 10 typically indicate a likely anxiety disorder

The PCL-C is a 17-item self-report scale based on DSM-IV criteria for PTSD, designed to assess symptom severity over the past month in civilians without linking symptoms to a specific event. It uses a 5-point Likert scale (1-5) for each item, with total scores ranging from 17 to 85. Scores above 44 indicate possible PTSD.

Abuse Assessment Screen (A.A.S.) is as a clinician-administered sexual and physical violence assessment tool for use in medical practice. A.A.S. includes five questions about the experience of abusive behavior.

The Pearlin Mastery Scale is a 7-item survey assessing an individual's sense of control over life circumstances, measuring a key psychological coping resource. It uses a 4-point Likert scale (1=Strongly Disagree to 4=Strongly Agree), with total scores ranging from 7 to 28; higher scores indicate greater mastery.

MAKS has been developed to measure mental health-related knowledge. The tool assesses and tracks stigma-related mental health knowledge among the general public. The Mental Health Knowledge Schedule (MAKS) uses a 5-point Likert scale to measure stigma-related knowledge (items 1-6) and illness recognition (items 7-12). Only the first 6 items are scored for knowledge, ranging from 6 to 30, with higher scores indicating greater knowledge. "Don't know" is generally scored as neutral (3).

The SF-12 is a self-reported outcome measure assessing the impact of health on an individual's everyday life.

The SF-12 health survey is scored by transforming responses into two main components: the Physical Component Summary (PCS) and Mental Component Summary (MCS). Using norm-based scoring, the average score for each component is 50, with a standard deviation of 10. Higher scores indicate better health-related quality of life, while scores below 50 suggest lower, below-average health.

The INQ measures beliefs about the extent to which individuals believe their need to belong is met or unmet, as well as the extent to which they perceive themselves to be a burden on the people in their lives. It uses a 7-point Likert scale (1 = "not at all true for me" to 7 = "very true for me") to rate items, with higher total scores indicating higher risk.