The Suicide Assessment Kit-Modified Interview (SAK-MI): Development and Validation of a Modified Clinical Interview for the Assessment of Suicidal Thoughts and Behavior in Autistic Adults

The increased prevalence of suicide among autistic people highlights the need for validated clinical suicide screening and assessment instruments that are accessible and meet the unique language and communication needs of this population. We describe the preliminary psychometric validation of the Suicide Assessment Kit-Modified Interview (SAK-MI), in a sample of 98 autistic adults (58% women, 34% men, 7% nonbinary; MAGE=41.65, SD=12.96). A four-item negative affect score derived from the SAK-MI demonstrated adequate reliability (ω=.796, BCa 95% CI [.706, .857]), as well as good convergent validity with related measures. Ordinal SAK-MI “categories” (1–5) demonstrated divergent validity (r=-.067–.081) and good convergent validity, strongly correlating with mental health (r=.446–.744) and suicide assessment instruments (r=.576–.696). SAK-MI categories showed strong ability to predict participants identified by clinicians as “above low risk” of future suicide attempt (AUC=.887, posterior Mdn=.889, 95% CrI [.810, .954], PAUC>0.8=.976). SAK-MI classifications > “Category 3” provided an observed sensitivity of .750 (Mdn=.810, [.669, .948], PSe>0.8=.544) and an observed specificity of .895 (Mdn=.899, [.833, .956], PSp>0.8=.995) for “above low risk” status. Our findings indicate that the SAK-MI is a psychometrically strong clinical assessment tool for suicidal behavior that can be validly administered to autistic adults without intellectual disability.