Assessing Functional Impairment and Distress Associated with the Suicide Crisis Syndrome in Psychiatric Inpatients

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For a disorder to be included in the Diagnostic and Statistical Manual of Mental Disorders (DSM), it must be associated with clinically significant distress or functional impairment across major life domains. This study examined the relationship between SCS and both distress and functional impairment in a psychiatric inpatient sample to assess its clinical significance and potential DSM inclusion. A total of 218 psychiatric inpatients completed the clinician-administered SCS Checklist (SCS-C), the self-report Suicide Crisis Inventory-2 (SCI-2), and the Sheehan Disability Scale. Psychiatric diagnoses were determined using the Mini International Neuropsychiatric Interview (MINI). Analyses included independent samples t-tests, hierarchical regression, and multiple regressions. Participants meeting diagnostic criteria for SCS reported significantly greater impairment and distress across all Sheehan domains (Cohen’s ds = 0.33–0.95). Hierarchical regressions showed that SCS accounted for additional variance in functional impairment beyond other psychiatric diagnoses (ΔR² = .042–.116, ps ≤ .002), particularly in family and social functioning. Among individuals with SCS, higher SCI-2 scores were associated with greater distress and impairment (partial η² = .057–.239), with affective disturbance and social withdrawal emerging as primary contributors. These findings demonstrate that SCS, measured both categorically and dimensionally, is linked to clinically significant distress and impairment across work, social, and family domains, providing empirical support for its potential recognition as a DSM disorder. Suicide Crisis Syndrome Functional Impairment Distress Suicide prevention Introduction Suicide remains a global public health crisis (World Health Organization, 2025 ), yet traditional risk assessment models—often reliant on self-reported suicidal ideation or past attempts—fail to capture acute risk states (Ribeiro et al., 2019 ; Woodford et al., 2019 ). The Suicide Crisis Syndrome (SCS) addresses this gap as a proposed diagnostic entity characterized by five core features: entrapment, hyperarousal, cognitive dysfunction, social withdrawal, and affective disturbance (Bloch-Elkouby et al., 2021 ). Unlike chronic risk models, the SCS identifies a time-limited, high-risk state amenable to immediate intervention, offering a paradigm shift from static risk factors to dynamic, actionable clinical targets. The SCS represents an acute crisis state precipitating suicidal behavior, theorized to emerge rapidly in the hours or days prior to a suicide attempt (Galynker et al., 2017 , 2024 ). It was introduced based on clinical observations of patients who denied suicidal ideation (SI) yet went on to attempt suicide combined with conceptual formulations of suicidal crises (Hendin et al., 2001 ) and empirical findings on psychological markers indicative of suicidal risk (Schuck et al., 2019 ), prompting efforts to characterize a pre-suicidal mental state that can be identified regardless of SI disclosure. Namely, the first criterion of the SCS (Criterion A) is a continuous and intense feeling of frantic hopelessness or entrapment. This feeling is characterized by an urgent yearning to leave or avoid an unpleasant life event that is deemed intolerable. The second criterion (Criterion B) includes four affective cognitive, physiological, and social domains that are linked to entrapment: affective disturbances, loss of cognitive control, hyperarousal, and social withdrawal. This construct has since been supported by empirical work linking SCS symptoms to imminent suicidal behavior across diverse populations (Bloch-Elkouby et al., 2021 ; Galynker et al., 2017 ; Yaseen et al., 2019 ) and has establish cross-national presence (Melzer et al., 2025; Menon et al., 2024 ; Rogers et al., 2023 ) and has been associated with stressful life events cross-culturally (Rogers et al., 2023 ). Measures of SCS have been translated and validated in many countries and established cross-national presence (Chia-Yi Wu et al., 2022 ; Park et al., 2023 ; Peper-Nascimento et al., 2024 ). In addition, the syndrome has been shown to be predictive of imminent short-term suicidality (Bafna et al., 2022 ; Rogers et al., 2021 ; 2022 ), as well as its implementation in several healthcare systems was strongly predictive of clinician decision-making (Karsen et al., 2023 ; Osváth et al., 2025 ). A critical criterion for inclusion in the Diagnostic and Statistical Manual of Mental Disorders (DSM) is evidence that a syndrome causes clinically significant distress or functional impairment across life domains. While the SCS has been associated with imminent suicidal behavior (Bloch-Elkouby et al., 2021 ; Galynker et al., 2017 ; Yaseen et al., 2019 ), no study to date has examined whether it meets the DSM criterion of clinically significant distress or impairment which is essential for diagnostic recognition. Individuals with SCS report profound psychological pain and a sense of inescapability (Bloch-Elkouby et al., 2021 ; Galynker et al., 2017 ) that is highly interconnected with all the other SCS symptoms (Bloch-Elkouby et al., 2021 ) but empirical data on how these symptoms disrupt work, relationships, and daily responsibilities—a benchmark for psychiatric diagnoses—are lacking. In psychiatric diagnoses, distress refers to subjectively experienced emotional suffering that is persistent, intense, and disruptive to one’s well-being. It often manifests as overwhelming anxiety, despair, or irritability, and signals the internal toll of a mental health condition. Functional impairment reflects “observable disruptions in a person’s ability to carry out expected roles or daily activities across key life domains” (Phillips, 2009 ). The American Psychiatric Association (APA) defines a mental disorder as a condition that causes both an individual distress and functioning impairment. The DSM emphasizes that both internal distress and external dysfunction must be present or clinically significant for a syndrome to be considered a mental disorder (American Psychiatric Association, 2013 , 2022 ). Accordingly, characterizing how SCS interferes with everyday functioning is essential to validating it as a distinct diagnosable clinical entity. The study aims to fill this critical gap by investigating the association between the SCS and and subjective distress and functional impairment in key life domains. We hypothesize that: Psychiatric inpatients who meet criteria for an SCS diagnosis will exhibit higher levels of distress and dysfunction than those without such a diagnosis. A diagnosis of SCS will independently contribute to distress and dysfunction above and beyond that attributable to other psychiatric diagnoses. Among those with SCS, SCS severity, measured dimensionally, will correlate with level of distress and dysfunction across work/school, social, and family roles. As an exploratory aim, we will also assess whether specific SCS subdomains emerge as primary drivers of impairment or distress. Methods Participants As part of a larger study assessing the implementation of SCS screening in a large hospital system in New York City, a total of 218 adults were recruited from psychiatric inpatient units within 72 hours of admission between March 2024 and June 2025. Research assistants approached eligible participants during their intake process and explained the purpose and procedures of the study. After obtaining informed consent, participants completed a battery of administered and self-report measures. Inclusion criteria required participants to be adults (aged 18 or older) admitted to the inpatient psychiatric unit, English-speaking, and capable of providing informed consent as determined by the clinical team. Exclusion criteria included significant cognitive impairment or medical instability that would interfere with the completion of study procedures, as determined by the treating medical team on the unit. The sample had a mean age of 32.19 years (SD = 12.82) and represented the diverse patient population served by this urban academic medical center. The study protocol was approved by the hospital’s Institutional Review Board, and all procedures adhered to ethical standards for research involving human subjects. Measures Suicide Crisis Syndrome Checklist (SCS-C) The Suicide Crisis Syndrome Checklist (SCS-C) is a clinician-administered tool rating the presence or absence of 15 symptoms grouped into the five symptom domains of SCS. A categorical diagnosis of SCS is established when at least one symptom of every domain is present. The SCS-C was designed as a brief clinical tool to diagnose SCS in healthcare settings and demonstrates good internal consistency in our current sample (α = .856) when retrospectively assessing symptoms present directly prior to hospitalization. The implementation of the SCS-C is currently being studied in the Mount Sinai Health System following strong results for similar brief clinician-administered SCS assessments in other healthcare settings in Chicago, Illinois (Cohen et al., 2024 ; Karsen et al., 2023 ), and Pecs, Hungary Osváth et al., 2025 ). The SCS-C was administered via semi-structured interview by the research team. It was independently validated and showed strong reliability and validity (Bloch-Elkouby et al., 2025 ). Revised Suicide Crisis Inventory (SCI-2) The Revised Suicide Crisis Inventory (SCI-2; Bloch-Elkouby et al., 2021 ) is a 61-item self-report questionnaire assessing the severity of SCS symptoms dimensionally. The SCI-2 yields a continuous score as well as subscale scores for each of the five symptom domains: entrapment, affective disturbance, cognitive dysfunction, hyperarousal, and social withdrawal. Items ask about the most severe symptoms over the past several days and are rated on a 5-point Likert scale ranging from 0 (not at all) to 4 (extremely). The scale showed strong validity and association with near-term suicide risk (Bloch-Elkouby et al., 2021 ) and has since been translated and validated at least 10 different countries (Chia-Yi Wu et al., 2022 ; Park et al., 2023 ; Peper-Nascimento et al., 2024 ). The SCI-2 was completed by participants following an intake interview administered by the research team. Sheehan Disability Scale The Sheehan Disability Scale (Sheehan et al., 1997 ) is a brief, validated measure of functional impairment and distress across three domains: work/school, social life, and family responsibilities. Versions of the scale have been well-validated and widely used to measure the impact of a psychiatric disorder on an individual’s recent distress and dysfunction (Arbuckle et al., 2009 ; Leon et al., 1992 , 1997 ; Luciano et al., 2010 ). The scale was administered via semi-structured interview by the research team. Participants were explicitly asked about their distress and dysfunction in reference to the symptoms they experienced directly prior to hospitalization, including those endorsed on the SCS-C. Mini-International Neuropsychiatric Interview (MINI) The MINI ((Sheehan, 2016) is a structured interview designed to assess the presence of psychiatric diagnoses based on DSM and ICD criteria. This study utilized modules from the MINI 7.0 for DSM-5 (Sheehan, 2016) to assess current Major Depressive Episodes (MDE), Panic Disorder (PD), Obsessive-Compulsive Disorder (OCD), Post-Traumatic Stress Disorder (PTSD), and Psychotic Disorders. MINI diagnoses were entered as covariates in multivariate analyses to assess whether SCS predicted functional impairment or distress above and beyond other psychiatric diagnoses (Hypothesis 2). Data analysis plan For Hypothesis 1, to assess group differences in functional impairment and distress, independent samples t-tests compared individuals with and without a SCS diagnosis on Sheehan Disability Scale items (e.g., work/school, social life, family life disruption and distress, days lost, and days unproductive). Effect sizes were calculated using Cohen’s d (Cohen, 1988 ). For Hypothesis 2, a series of hierarchical multiple regression models were used to evaluate the incremental validity of an SCS diagnosis above and beyond existing psychiatric diagnoses derived from the MINI. In each model, Step 1 included psychiatric diagnoses from the MINI (e.g., major depressive episode, PTSD, psychosis, OCD, panic disorder, mood disorder with psychotic features); Step 2 added the SCS-C diagnosis (yes/no). The change in explained variance (ΔR²) and corresponding p-values was used to evaluate incremental validity. For Hypothesis 3, to examine the dimensional relationship between SCS symptom severity and functional outcomes, multiple linear regressions were performed among participants who met criteria for SCS on the SCS-C using the total score of the Suicide Crisis Inventory-2 (SCI-2) as a continuous predictor. Exploratory multiple regression analyses were also conducted to assess the contributions of individual SCS subdomains (e.g., affective disturbance, entrapment, social withdrawal) to each of functional impairment and distress. Composite scores were computed to reduce the number of dependent variables and limit Type I error. The disability composite was calculated as the mean of the three original SDS functioning items, and the distress composite as the mean of the three added distress items. Internal consistency of each composite was evaluated using Cronbach’s alpha (α = .79 and α = .83, respectively). A Productivity index was computed as the sum of days lost and days unproductive (α = .63, consistent with expectations for a 2-item scale). Significance was set at p < .05 for all analyses. Missing data were handled using listwise deletion for each analysis. Final sample sizes for specific analyses varied depending on the availability of complete data for outcome and predictor variables. All analyses were conducted using IBM SPSS Statistics (Version 30.0). Results Sample characteristics The total sample consisted of 218 psychiatric inpatients (M age = 32.19, SD = 12.82), with 49.5% identifying as female, 38% as male, and the remainder identifying as non-binary (10%), transgender (2.7%), or other (1.8%). Participants identified as White (46.3%), Black (18.8%), Asian (10.1%), Native American (2.3%), multiracial (9.6%), or other (10.5%). No significant demographic differences were found between participants with and without SCS. The mean age was similar across groups (t (216) = 0.48, p = .635), and chi-square analyses showed no group differences in gender identity (χ² (5, N = 211) = 4.42, p = .491) or racial identity (χ² (7, N = 217) = 6.54, p = .478). These findings suggest that demographic variables are unlikely to account for differences in clinical outcomes (See Table 1 ). Table 1 Demographic Characteristics of the Participants Variable Total (N = 218) SCS Absent (n = 62) SCS Present (n = 156) Test Statistic p Age (years) M = 32.19 (12.82) M = 33.23 (14.49) M = 31.91 (32.30) t (216) = 0.48 .635 Gender Identity χ²(5, N = 211) = 4.42 .491 Male 83 (38.0%) 24 (28.9%) 59 (71.1%) Female 108 (49.5%) 34 (31.5%) 74 (68.5%) Non-binary 10 (4.6%) 2 (20.0%) 8 (80.0%) Transgender man 4 (1.8%) 0 (0.0%) 4 (100.0%) Transgender woman 2 (0.9%) 1 (50.0%) 1 (50.0%) Other 4 (1.8%) 0 (0.0%) 4 (100.0%) Race χ²(7, N = 217) = 6.54 .478 White 101 (46.3%) 29 (28.7%) 72 (71.3%) Black 41 (18.8%) 12 (29.3%) 29 (70.7%) Asian 22 (10.1%) 3 (13.6%) 19 (86.4%) Native American 5 (2.3%) 1 (20.0%) 4 (80.0%) Two or more races 21 (9.6%) 7 (33.3%) 14 (66.7%) Other 23 (10.5%) 9 (35.3%) 14 (64.7%) Functional Impairment and Distress Among Individuals with and without SCS Individuals with an SCS diagnosis reported significantly greater distress and functional impairment across all ten domains of the Sheehan Disability Scale. The largest effects were observed for family life distress (p < .001, Cohen’s d = 0.947) and social life distress (p < .001, d = 0.872), followed by social life disruption (p < .001, d = .858) and work/school distress (p < .001, d = 794). Individuals with SCS also reported more unproductive days or days lost due to their symptoms (p = .001 and .008 respectively) than those without SCS. These results demonstrate that SCS is associated with widespread and clinically meaningful impairment, particularly in social, family, and occupational functioning. (see Table 2 ). Table 2 Comparison of Functional Impairment in 10 Sheehan Disability Scale Domains in Psychiatric Inpatients with and without SCS Sheehan Disability Scale Item SCS Negative SCS Positive p Cohen’s d Work/School Disruption 5.51 (3.54) 7.75 (2.49) < .001 -0.779 Social Life Disruption 4.39 (3.48) 6.97 (2.78) < .001 -0.858 Family Life Disruption 5.04 (3.70) 7.10 (2.89) .001 -0.650 Days Lost 2.25 (2.84) 3.34 (2.59) .008 -0.408 Days Unproductive 2.55 (2.81) 4.47 (2.68) < .001 -0.705 Work/School Distress 4.81 (3.63) 7.30 (2.88) < .001 -0.794 Social Life Distress 4.18 (3.57) 6.97 (3.01) < .001 -0.872 Family Life Distress 4.35 (3.70) 7.24 (2.70) < .001 -0.947 Note. SCS as measured using the SCS-C. Incremental Validity of SCS Diagnosis Over Other Psychiatric Diagnoses An SCS diagnosis accounted for significant additional distress and dysfunction beyond that attributable to MINI-based psychiatric diagnoses. The largest increases in explained variance (ΔR²) were observed for family life distress (ΔR² = .116, p < .001), work/school distress (ΔR² = .068, p < .001), and social life distress (ΔR² = .053, p < .001). Significant improvements in model fit were also observed for social life disruption (ΔR² = .054, p < .001), family life disruption (ΔR² = .045, p = .002), and days unproductive (ΔR² = .042, p = .001). The only domain that was not significantly impacted by the addition of SCS-C was days lost (p = .115). These results demonstrate the incremental validity of SCS-C in predicting functional distress and impairment beyond standard psychiatric diagnoses (see Table 3 ). Table 3 Hierarchical Regressions Assessing the Contribution of Other Diagnoses and SCS to Distress and Dysfunction in Each of 10 Domains on the Sheehan Disability Scale Sheehan Disability Scale Item R² Step 1 (MINI only) R² Step 2 (MINI + SCS) ΔR² p(ΔR²) Work/School Disruption .239 .306 .068 < .001 Social Life Disruption .336 .390 .054 < .001 Family Life Disruption .135 .180 .045 .002 Days Lost .185 .197 .011 .115 Days Unproductive .252 .294 .042 .001 Work/School Distress .242 .305 .062 < .001 Social Life Distress .306 .360 .053 < .001 Family Life Distress .191 .307 .116 < .001 Note. Diagnoses assessed using the M.I.N.I. and the SCS-C Dimensional SCS Severity (SCI-2) and Functional/Distress Outcomes SCI-2 scores of those who tested positive for SCS using the categorical SCS-C ranged between 9 and 226 with a mean of 139.4 and a standard deviation of 54.7. SCI-2 total scores were significantly associated with all Sheehan Disability Scale items among individuals with an SCS-C diagnosis (see Table 4 ). The strongest associations were with social life distress (p < .001, partial η² = .239), family life distress (p < .001, partial η² = .197), work/school disruption (p < .001, partial η² = .180), and social life disruption (p < .001, partial η² = .184). Significant but smaller effects were also found for family life disruption, days unproductive, and days lost due to existing symptoms. These findings support the hypothesis that SCI-2 severity scores are robust predictors of distress and dysfunction across life domains (Table 4 ). Table 4 Association Between SCS severity and Sheehan Disability Scores Sheehan Disability Scale item F (1,df) p Partial η² Work/School Disruption 26.20 < .001 .180 Social Life Disruption 29.69 < .001 .184 Family Life Disruption 11.99 < .001 .084 Days Lost 7.70 .006 .057 Days Unproductive 9.15 .003 .068 Work/School Distress 12.66 < .001 .114 Social Life Distress 34.20 < .001 .239 Family Life Distress 26.48 < .001 .197 Note. SCS severity as measured by the SCI-2 total score Exploratory Analysis of SCS Subdomains Two multiple regression models were conducted to evaluate the contributions of specific SCS subdomains (entrapment, affective disturbance, cognitive dysfunction, hyperarousal, and social withdrawal) to Sheehan disability and distress outcomes. The model predicting disability was significant, F(5, 188) = 23.64, p < .001, explaining 39% of the variance (R² = .39). Among the predictors, only social withdrawal was a significant positive predictor of disability (β = .26, p = .004). No other domains reached significance. The model predicting distress was also significant, F (5, 154) = 17.48, p < .001, accounting for 36% of the variance (R² = .36). Both affective disturbance (β = .37, p = .041) and social withdrawal (β = .27, p = .016) emerged as significant predictors. These findings suggest that while the SCI-2 total score remains the most robust predictor of overall impairment, individual symptom domains have different effects on various aspects of functioning and distress (See Table 5 ). Table 5 Multiple Regression of SCS Subdomains and SDS Composite Outcomes SCS Subdomain Disability composite (β) p-value Distress composite (β) p-value Entrapment .09 .801 .15 .264 Affective disturbance .21 .195 .37 .041* Loss of cognitive control .14 .217 − .24 .063 Hyperarousal − .02 .875 .07 .640 Social withdrawal .26 .004* .272 .016* Note. Model R² = .39 for Disability, .36 for Distress; *p <. 05 Discussion The current study aimed to examine the relationship between SCS and functional impairment and distress in a psychiatric inpatient sample, with the goal of evaluating the clinical utility of SCS as a distinct and diagnostically meaningful construct. Individuals meeting criteria for SCS exhibited significantly greater disruption in work, social, and family domains, as well as more unproductive and lost days. The SCS-C diagnosis accounted for unique variance in impairment even after adjusting for other psychiatric diagnoses, supporting its incremental clinical value. Among those diagnosed with SCS, greater symptom severity was associated with more severe dysfunction, and exploratory analyses revealed that specific symptom clusters, particularly affective disturbance and social withdrawal were independently related to outcomes. Together, these results support SCS as a clinically meaningful construct and highlight the value of both overall syndrome severity and subdomain profiling in suicide risk assessment and intervention. Across all domains of the Sheehan Disability Scale, individuals with SCS reported significantly more impairment, with medium to large effect sizes (Cohen’s ds = 0.33–0.95). The most affected areas included family and social life, which are central to daily functioning and recovery. These findings suggest that SCS not only represents an internal psychological state, but it also reflects a breakdown in interpersonal and occupational functioning. This aligns with earlier work on the role of emotional dysregulation in acute suicidal states (Galynker et al., 2017 , 2024 ) and expands on it by empirically demonstrating that SCS is linked to measurable real-world impairment. Even though the cross-sectional design of the study prevents determination of causality, our participants were asked the functional impairment questions explicitly in response to SCS symptoms. Clinically, this underscores the need for preventative measures, such as family-based approaches and occupational support, alongside traditional psychiatric treatment for individuals who have previously experienced or are at risk of experiencing SCS. Second, we hypothesized that SCS-C diagnosis would demonstrate incremental validity in predicting distress beyond other psychiatric diagnoses. Prior research has shown that conditions like major depressive disorder, PTSD, psychosis, and OCD are each associated with significant functional impairment across domains of daily life (Boyd et al., 2018 ; Fulford et al., 2013 ; Ito et al., 2015 ; Sahoo et al., 2017 ). The addition of an SCS diagnosis to these existing diagnoses in hierarchical regression significantly improved model fit across several Sheehan domains. Notably, it explained an additional 11.6% of the variance in family life distress, 6.8% in work/school distress, and 5.4% in social life disruption. These findings suggest that SCS captures an acute crisis state that is not fully explained by conventional diagnoses, supporting its utility as a diagnostic construct in its own right, reinforcing the argument for formally recognizing SCS in diagnostic manuals. In addition to categorical diagnosis, the severity of SCS, as measured dimensionally by the SCI-2, was strongly associated with all functional impairment and distress outcomes. The strongest effects were seen in interpersonal domains, including family and social life distress (partial η²s = .197–.239). It is notable that this effect was evident within the restricted sample of those meeting fairly conservative criteria for SCS, highlighting the value of using dimensional assessment tools like the SCI-2 to monitor symptom fluctuations over time. Clinically, SCI-2 scores could inform the need for crisis stabilization or guide discharge planning. Exploratory analyses revealed that affective disturbance and social withdrawal were significantly associated with overall disability and distress outcomes, which is consistent with prior research linking emotional dysregulation with interpersonal and social dysfunction (Carmassi et al., 2022 ). These domain-specific effects suggest that not all SCS symptoms contribute equally to impairment and that individualized preventative approaches targeting specific symptom dimensions may be most effective in alleviating the risk of developing SCS. Clinical Implications Recognizing SCS within diagnostic systems like the DSM may support earlier identification of individuals in acute suicidal crises and promote more targeted risk detection and prevention strategies. Our results, along with prior evidence demonstrating the predictive validity of SCS for suicidal outcomes (Galynker et al., 2017 ; Bloch-Elkouby et al., 2024 ; Parghi et al., 2021 ), its clinical utility in risk assessment (Cohen et al., 2024 , Karsen et al., 2023 ), and preliminary responsiveness to acute interventions (Garagiola et al., 2025 ), underscore its relevance in suicide prevention. Given the significant functional disruption observed, including occupational impairment and family-associated distress, integrating assessments of functional impairment into suicide risk evaluations may enhance clinical decision-making and facilitate crisis prevention. Limitations and Future Directions Several limitations should be considered when interpreting these results. The cross-sectional design limits conclusions about the direction of the relationship between SCS symptoms and functional impairment. The sample was exclusively drawn from the inpatient unit which may limit generalizability to community populations experiencing less severe crises. The use of both self-report and researcher-administered measures may have possibly alleviated the potential responses biases associated with self-report measures. Additionally, while we controlled for several covariates, unmeasured factors like comorbid medical conditions or individual psychosocial stressors may influence the observed relationships. Future research should address these limitations through longitudinal designs that track functional changes throughout SCS episodes and recovery. Studies comparing inpatient and outpatient populations could clarify whether impairment patterns differ by crisis severity. Research examining whether functional improvement mediates reduced suicide risk could inform treatment approaches. Conclusion This study strengthens the empirical basis for the SCS as a clinically valid construct by demonstrating its strong association with daily functioning. Individuals with SCS reported significantly greater impairment, and symptom severity emerged as a robust predictor of distress across all functional areas, with subdomain analyses revealing unique contributions such as emotional disturbance to family life disruption, and social withdrawal to familial distress. These results highlight the utility of assessing SCS severity and symptom profiles in clinical settings to guide targeted interventions. Future research should prioritize developing preventative measures that would mitigate the specific functional impairments linked to SCS, aiming to reduce both acute suicide risk and longer-term disability. Declarations Data availability: The datasets used for the current study are not publicly available due to patient confidentiality but are available from the corresponding author on reasonable request and with appropriate institutional approvals. Funding: This work was supported by the American Foundation for Suicide Prevention under grant #TBT-1-136-22 (PI: Igor Galynker, MD, PhD). Conflict of interest disclosure: The authors declare that they have no conflicts of interest relevant to this manuscript. Ethics approval: The study was conducted in accordance with the Declaration of Helsinki and approved by the Institutional Review Board of the Icahn School of Medicine at Mount Sinai (Protocol #23-00911). Patient consent: Written informed consent was obtained from all participants prior to participation. Clinical trial number: Not applicable Permission to reproduce material from other sources: No previously published material was reproduced in this manuscript. Author Contribution R.E. conceived the study, conducted the formal statistical analyses, and drafted the initial manuscript.E.W. and B.P. contributed to manuscript drafting and substantive intellectual content.B.P. prepared and formatted all tables.T.U. managed the references and contributed to general manuscript editing.S.B.E. and L.J.C. critically reviewed the manuscript and provided important revisions for intellectual content.I.G. supervised the study, provided overall conceptual guidance, and oversaw all stages of the research and manuscript preparation. Acknowledgement This work was supported by the American Foundation for Suicide Prevention (Grant #TBT-1-136-22; PI: Igor Galynker, MD, PhD) References American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition). American Psychiatric Association. https://doi.org/10.1176/appi.books.9780890425596 American Psychiatric Association. (2022). 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The revised suicide crisis inventory (SCI-2): Validation and assessment of prospective suicidal outcomes at one month follow-up. Journal of Affective Disorders , 295 , 1280–1291. https://doi.org/10.1016/j.jad.2021.08.048 Bloch-Elkouby, S., Rogers, M.L., Goncearenco, I., Yanez, N., Nemeroff, C., Chennapragada, L., Cohen, L.J., Galynker, I. (2024). The narrative crisis model of suicide: A review of empirical evidence for an innovative dynamic model of suicide and a comparison with other theoretical frameworks, Personalized Medicine in Psychiatry , 45–46. https://doi.org/10.1016/j.pmip.2024.100131 Bloch-Elkouby, S., Cohen, L. J., Gorman, B., El Hayek, R., Apter, Y., Wheeler, E., Byounyoung, P., Prekas, S., & Galynker, I. (2025). The clinician rated suicide crisis syndrome checklist (SCS-C): Structure, reliability, and concurrent validity among adult psychiatric inpatients. Journal of Affective Disorders . Manuscript under review. Boyd, J. E., Protopopescu, A., O’Connor, C., Neufeld, R. 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Routledge. https://doi.org/10.4324/9780203771587 Cohen, L. J., White, B. J., Miller, F. E., Karsen, E. F., & Galynker, I. I. (2024). Diagnosis of the Suicide Crisis Syndrome in the Emergency Department Associated With Significant Reduction in 3-Month Readmission Rates. The Journal of Clinical Psychiatry , 85 (4). https://doi.org/10.4088/JCP.24m15320 Fulford, D., Niendam, T. A., Floyd, E. G., Carter, C. S., Mathalon, D. H., Vinogradov, S., Stuart, B. K., & Loewy, R. L. (2013). Symptom dimensions and functional impairment in early psychosis: More to the story than just negative symptoms. Schizophrenia Research , 147 (1), 125–131. https://doi.org/10.1016/j.schres.2013.03.024 Galynker, I., Bloch‐Elkouby, S., & Cohen, L. J. (2024). Suicide crisis syndrome: A specific diagnosis to aid suicide prevention. World Psychiatry , 23 (3), 362–363. https://doi.org/10.1002/wps.21229 Galynker, I., Yaseen, Z. S., Cohen, A., Benhamou, O., Hawes, M., & Briggs, J. (2017). Prediction of suicidal behavior in high risk psychiatric patients using an assessment of acute suicidal state: The suicide crisis inventory: Galynker et al. Depression and Anxiety , 34 (2), 147–158. https://doi.org/10.1002/da.22559 Garagiola, E. R., Wheeler, E., Park, B. D., Suarez, N., El Hayek, R., Galynker, I., & Cohen, L. J. (2025). Treatment response of suicide crisis syndrome (SCS) during psychiatric hospitalization: A naturalistic study. Suicide and Life-Threatening Behavior . Manuscript under review. Hendin, H., Maltsberger, J. T., Lipschitz, A., Haas, A. P., & Kyle, J. (2001). Recognizing and Responding to a Suicide Crisis. Suicide and Life-Threatening Behavior , 31 (2), 115–128. https://doi.org/10.1521/suli.31.2.115.21515 Ito, M., Bentley, K. H., Oe, Y., Nakajima, S., Fujisato, H., Kato, N., Miyamae, M., Kanie, A., Horikoshi, M., & Barlow, D. H. (2015). Assessing Depression Related Severity and Functional Impairment: The Overall Depression Severity and Impairment Scale (ODSIS). PLOS ONE , 10 (4), e0122969. https://doi.org/10.1371/journal.pone.0122969 Karsen, E., Cohen, L. J., White, B., Luca, G. P. D., Goncearencoa, I., Galynker, I. I., & Miller, F. E. (2023). Impact of the Abbreviated Suicide Crisis Syndrome Checklist on Clinical Decision Making in the Emergency Department. The Journal of Clinical Psychiatry , 84 (3). https://doi.org/10.4088/JCP.22m14655 Lecrubier, Y., Sheehan, D., Weiller, E., Amorim, P., Bonora, I., Sheehan, K. H., Janavs, J., & Dunbar, G. (1997). The Mini International Neuropsychiatric Interview (MINI). A short diagnostic structured interview: Reliability and validity according to the CIDI. European Psychiatry , 12 (5), 224–231. https://doi.org/10.1016/S0924-9338(97)83296-8 Leon, A. C., Olfson, M., Portera, L., Farber, L., & Sheehan, D. V. (1997). Assessing Psychiatric Impairment in Primary Care with the Sheehan Disability Scale. The International Journal of Psychiatry in Medicine , 27 (2), 93–105. https://doi.org/10.2190/T8EM-C8YH-373N-1UWD Leon, A. C., Shear, M. K., Portera, L., & Klerman, G. L. (1992). Assessing impairment in patients with panic disorder: The Sheehan Disability Scale. Social Psychiatry and Psychiatric Epidemiology , 27 (2), 78–82. https://doi.org/10.1007/BF00788510 Luciano, J. V., Bertsch, J., Salvador‐Carulla, L., Tomás, J. M., Fernández, A., Pinto‐Meza, A., Haro, J. M., Palao, D. J., & Serrano‐Blanco, A. (2010). Factor structure, internal consistency and construct validity of the Sheehan Disability Scale in a Spanish primary care sample. Journal of Evaluation in Clinical Practice , 16 (5), 895–901. https://doi.org/10.1111/j.1365-2753.2009.01211.x Melzer L, Claus C, Posen N, Forkmann T, Rogers ML, Teismann T. Psychometric Evaluation of the Revised Suicide Crisis Inventory (SCI-2) in Germany: Factor Structure, Reliability, and Validity in an Online and Outpatient Sample. Clin Psychol Psychother. 2025 May-Jun;32(3):e70106. doi: 10.1002/cpp.70106. PMID: 40552901; PMCID: PMC12186597. Menon V, Balasubramanian I, Rogers ML, Grover S, Lakdawala B, Ranjan R, Sarkhel S, Nebhinani N, Kallivayalil RA, Raghavan V, Mishra KK, Aneja J, Abhivant N, Deep R, Singh LK, De Sousa A, Nongpiur A, Subramanyam AA, Mohapatra D, Kar SK, Dhiman V, Kumar PNS, Shreekantiah U, Bhandari SS, Ransing R, Ramasubramanian V, Praharaj SK. Factor structure, reliability, and validity of the revised Suicide Crisis Inventory in major depression: A multicentric Indian study. J Affect Disord. 2024 Jan 15;345:226-233. doi: 10.1016/j.jad.2023.10.102. Epub 2023 Oct 26. PMID: 37898473. Osváth, P., Molnár, C., Lovig, C., Major, F. N., Venczák, S., Fekete, S., Tényi, T., Cohen, L., Galynker, I., & Vörös, V. (2025). Az akut szuicid veszély értékelése: A komplex rizikóbecslés lehetőségei a klinikai gyakorlatban. Orvosi Hetilap , 166 (4), 146–153. https://doi.org/10.1556/650.2025.33211 Parghi, N., Chennapragada, L., Barzilay, S., Newkirk, S., Ahmedani, B., Lok, B., & Galynker, I. (2021). Assessing the predictive ability of the suicide crisis inventory for near-term suicidal behavior using machine learning approaches. International Journal of Methods in Psychiatric Research, 30(1) , e1863. https://doi. org/10.1002/mpr.1863 Park, J. Y., Rogers, M. L., Bloch-Elkouby, S., Richards, J. A., Lee, S., Galynker, I., & You, S. (2023). Factor Structure and Validation of the Revised Suicide Crisis Inventory in a Korean Population. Psychiatry Investigation , 20 (2), 162–173. https://doi.org/10.30773/pi.2022.0208 Peper-Nascimento, J., Rogers, M. L., Richards, J. A., Diaz, A. P., Ceretta, L. B., Keller, G. S., Quevedo, J., Galynker, I., & Valvassori, S. S. (2024). Suicide Crisis Inventory-2: Factor structure, internal consistency, and validity in a Brazilian sample. Brazilian Journal of Psychiatry . https://doi.org/10.47626/1516-4446-2023-3366 Phillips, M. R. (2009). Is distress a symptom of mental disorders, a marker of impairment, both or neither? World Psychiatry: Official Journal of the World Psychiatric Association (WPA) , 8 (2), 91–92. Ribeiro, J. D., Huang, X., Fox, K. R., Walsh, C. G., & Linthicum, K. P. (2019). Predicting Imminent Suicidal Thoughts and Nonfatal Attempts: The Role of Complexity. Clinical Psychological Science , 7 (5), 941–957. https://doi.org/10.1177/2167702619838464 Rogers ML, Vespa A, Bloch-Elkouby S, Galynker I. Validity of the modular assessment of risk for imminent suicide in predicting short-term suicidality. Acta Psychiatr Scand. 2021 Dec;144(6):563-577. doi: 10.1111/acps.13354. Epub 2021 Aug 10. PMID: 34333759. Rogers ML, Bafna A, Galynker I. Comparative clinical utility of screening for Suicide Crisis Syndrome versus suicidal ideation in relation to suicidal ideation and attempts at one-month follow-up. Suicide Life Threat Behav. 2022 Oct;52(5):866-875. doi: 10.1111/sltb.12870. Epub 2022 Apr 20. PMID: 35441411. Rogers ML, McMullen L, Liang Y, Perez N, Richards JA, Akülker G, Barzilay S, Bilici R, Blum Y, Chistopolskaya K, Dudeck M, Husain MI, Kuśmirek O, Luiz JM, Menon V, Pilecka B, Sadovnichaya V, Titze L, Valvassori SS, You S, Galynker I. Cross-national presence and sociodemographic correlates of the suicide crisis syndrome. J Affect Disord. 2023 May 15;329:1-8. doi: 10.1016/j.jad.2023.02.076. Epub 2023 Feb 23. PMID: 36828142. Rogers, M. L., Richards, J. A., Cao, E., Krumerman, M., Barzilay, S., Blum, Y., Chistopolskaya, K., Çinka, E., Dudeck, M., Husain, M. I., Yilmaz, F. K., Kravtsova, N. A., Kuśmirek, O., Menon, V., Peper-Nascimento, J., Pilecka, B., Titze, L., Valvassori, S. S., You, S., & Galynker, I. (2023). Associations between long-term and near-term stressful life events, suicide crisis syndrome, and suicidal ideation. International Journal of Stress Management, 30 (2), 209–221. Sahoo, P., Sethy, R. R., & Ram, D. (2017). Functional Impairment and Quality of Life in Patients with Obsessive Compulsive Disorder. Indian Journal of Psychological Medicine , 39 (6), 760–765. https://doi.org/10.4103/IJPSYM.IJPSYM_53_17 Schuck, A., Calati, R., Barzilay, S., Bloch‐Elkouby, S., & Galynker, I. (2019). Suicide Crisis Syndrome: A review of supporting evidence for a new suicide‐specific diagnosis. Behavioral Sciences & the Law , 37 (3), 223–239. https://doi.org/10.1002/bsl.2397 Sheehan. (2016, August 8). M.I.N.I. MINI INTERNATIONAL NEUROPSYCHIATRIC INTERVIEW . https://pdf.medenshealth.com/MINI-Standard.pdf Sheehan, D., Lecrubier, Y., Harnett Sheehan, K., Janavs, J., Weiller, E., Keskiner, A., Schinka, J., Knapp, E., Sheehan, M., & Dunbar, G. (1997). The validity of the Mini International Neuropsychiatric Interview (MINI) according to the SCID-P and its reliability. European Psychiatry , 12 (5), 232–241. https://doi.org/10.1016/S0924-9338(97)83297-X Woodford, R., Spittal, M. J., Milner, A., McGill, K., Kapur, N., Pirkis, J., Mitchell, A., & Carter, G. (2019). Accuracy of Clinician Predictions of Future Self‐Harm: A Systematic Review and Meta‐Analysis of Predictive Studies. Suicide and Life-Threatening Behavior , 49 (1), 23–40. https://doi.org/10.1111/sltb.12395 World Health Organization. (2025, March 25). Suicide . World Health Organization. https://www.who.int/news-room/fact-sheets/detail/suicide Yaseen, Z. S., Hawes, M., Barzilay, S., & Galynker, I. (2019). Predictive Validity of Proposed Diagnostic Criteria for the Suicide Crisis Syndrome: An Acute Presuicidal State. Suicide and Life-Threatening Behavior , 49 (4), 1124–1135. https://doi.org/10.1111/sltb.12495 Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8843649","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":592291977,"identity":"fcf9bc40-62d7-4fb6-bbad-361c517e4653","order_by":0,"name":"Rawad El Hayek","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+UlEQVRIiWNgGAWjYLACHgYGGQMgzdhQgRAhqIUHouUMyVoa24jQYt5+xvDDGwYbHnP2M4YPZ87bZi8/7QDjg7dtuLXInMkxlpzDkMZj2ZNjbLhx2+3EDbcTmA3n4tEiwZC7QZqH4TCPwYEcM8mH224nGEgnsEnz4tPC/3bzbx6G/zwG59+Y/3w457a9/OwE9t94tUjkbgPacoDH4EaOGePGhtuMDbcT2Jjxa3n/zXKOQTJQy7NiyRnHQH5JbJaccw6fw9KSb7ypsJMzOJ+88WNPDchhyQc/vCnDrQUCQJHCwGEA5TE2EFIPA+wPiFU5CkbBKBgFIwwAAJo9UkbmSwArAAAAAElFTkSuQmCC","orcid":"","institution":"Icahn School of Medicine at Mount Sinai","correspondingAuthor":true,"prefix":"","firstName":"Rawad","middleName":"El","lastName":"Hayek","suffix":""},{"id":592291978,"identity":"21737c0e-0bad-4318-be80-0ac17c859ee8","order_by":1,"name":"Erin Wheeler","email":"","orcid":"","institution":"Icahn School of Medicine at Mount Sinai","correspondingAuthor":false,"prefix":"","firstName":"Erin","middleName":"","lastName":"Wheeler","suffix":""},{"id":592291979,"identity":"8f64642d-ffcc-4ec5-a382-e7f5e406fb2c","order_by":2,"name":"Byoungwook Park","email":"","orcid":"","institution":"Icahn School of Medicine at Mount Sinai","correspondingAuthor":false,"prefix":"","firstName":"Byoungwook","middleName":"","lastName":"Park","suffix":""},{"id":592291980,"identity":"62ff3f54-ba3b-48b1-ac48-cdc9054bf219","order_by":3,"name":"Tyler Ulch","email":"","orcid":"","institution":"Columbia University","correspondingAuthor":false,"prefix":"","firstName":"Tyler","middleName":"","lastName":"Ulch","suffix":""},{"id":592291981,"identity":"884f1dde-35a0-4b13-a810-d9967b25ef5b","order_by":4,"name":"Lisa J Cohen","email":"","orcid":"","institution":"Icahn School of Medicine at Mount Sinai","correspondingAuthor":false,"prefix":"","firstName":"Lisa","middleName":"J","lastName":"Cohen","suffix":""},{"id":592291982,"identity":"6de9a975-c94e-4f3d-9689-fd4c738128e1","order_by":5,"name":"Sarah Bloch-Elkouby","email":"","orcid":"","institution":"Yeshiva University","correspondingAuthor":false,"prefix":"","firstName":"Sarah","middleName":"","lastName":"Bloch-Elkouby","suffix":""},{"id":592291983,"identity":"e8a33dc2-4b8b-44ad-afc6-dece390be272","order_by":6,"name":"Igor Galynker","email":"","orcid":"","institution":"Icahn School of Medicine at Mount Sinai","correspondingAuthor":false,"prefix":"","firstName":"Igor","middleName":"","lastName":"Galynker","suffix":""}],"badges":[],"createdAt":"2026-02-10 17:10:08","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8843649/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8843649/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":103050473,"identity":"e92241e7-68cf-4874-963f-be970c95956e","added_by":"auto","created_at":"2026-02-20 07:50:12","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":939141,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8843649/v1/d9c5c8ba-901e-49bc-ad9f-d28653f279ca.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Assessing Functional Impairment and Distress Associated with the Suicide Crisis Syndrome in Psychiatric Inpatients","fulltext":[{"header":"Introduction","content":"\u003cp\u003eSuicide remains a global public health crisis (World Health Organization, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2025\u003c/span\u003e), yet traditional risk assessment models\u0026mdash;often reliant on self-reported suicidal ideation or past attempts\u0026mdash;fail to capture acute risk states (Ribeiro et al., \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Woodford et al., \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). The Suicide Crisis Syndrome (SCS) addresses this gap as a proposed diagnostic entity characterized by five core features: entrapment, hyperarousal, cognitive dysfunction, social withdrawal, and affective disturbance (Bloch-Elkouby et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Unlike chronic risk models, the SCS identifies a time-limited, high-risk state amenable to immediate intervention, offering a paradigm shift from static risk factors to dynamic, actionable clinical targets.\u003c/p\u003e \u003cp\u003eThe SCS represents an acute crisis state precipitating suicidal behavior, theorized to emerge rapidly in the hours or days prior to a suicide attempt (Galynker et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2017\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). It was introduced based on clinical observations of patients who denied suicidal ideation (SI) yet went on to attempt suicide combined with conceptual formulations of suicidal crises (Hendin et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2001\u003c/span\u003e) and empirical findings on psychological markers indicative of suicidal risk (Schuck et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2019\u003c/span\u003e), prompting efforts to characterize a pre-suicidal mental state that can be identified regardless of SI disclosure. Namely, the first criterion of the SCS (Criterion A) is a continuous and intense feeling of frantic hopelessness or entrapment. This feeling is characterized by an urgent yearning to leave or avoid an unpleasant life event that is deemed intolerable. The second criterion (Criterion B) includes four affective cognitive, physiological, and social domains that are linked to entrapment: affective disturbances, loss of cognitive control, hyperarousal, and social withdrawal. This construct has since been supported by empirical work linking SCS symptoms to imminent suicidal behavior across diverse populations (Bloch-Elkouby et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Galynker et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Yaseen et al., \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2019\u003c/span\u003e) and has establish cross-national presence (Melzer et al., 2025; Menon et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Rogers et al., \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) and has been associated with stressful life events cross-culturally (Rogers et al., \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Measures of SCS have been translated and validated in many countries and established cross-national presence (Chia-Yi Wu et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Park et al., \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Peper-Nascimento et al., \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). In addition, the syndrome has been shown to be predictive of imminent short-term suicidality (Bafna et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Rogers et al., \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2022\u003c/span\u003e), as well as its implementation in several healthcare systems was strongly predictive of clinician decision-making (Karsen et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Osv\u0026aacute;th et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2025\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eA critical criterion for inclusion in the Diagnostic and Statistical Manual of Mental Disorders (DSM) is evidence that a syndrome causes clinically significant distress or functional impairment across life domains. While the SCS has been associated with imminent suicidal behavior (Bloch-Elkouby et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Galynker et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Yaseen et al., \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2019\u003c/span\u003e), no study to date has examined whether it meets the DSM criterion of clinically significant distress or impairment which is essential for diagnostic recognition. Individuals with SCS report profound psychological pain and a sense of inescapability (Bloch-Elkouby et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Galynker et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2017\u003c/span\u003e) that is highly interconnected with all the other SCS symptoms (Bloch-Elkouby et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) but empirical data on how these symptoms disrupt work, relationships, and daily responsibilities\u0026mdash;a benchmark for psychiatric diagnoses\u0026mdash;are lacking.\u003c/p\u003e \u003cp\u003eIn psychiatric diagnoses, distress refers to subjectively experienced emotional suffering that is persistent, intense, and disruptive to one\u0026rsquo;s well-being. It often manifests as overwhelming anxiety, despair, or irritability, and signals the internal toll of a mental health condition. Functional impairment reflects \u003cem\u003e\u0026ldquo;observable disruptions in a person\u0026rsquo;s ability to carry out expected roles or daily activities across key life domains\u0026rdquo;\u003c/em\u003e (Phillips, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2009\u003c/span\u003e). The American Psychiatric Association (APA) defines a mental disorder as a condition that causes both an individual distress and functioning impairment. The DSM emphasizes that both internal distress and external dysfunction must be present or clinically significant for a syndrome to be considered a mental disorder (American Psychiatric Association, \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2013\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Accordingly, characterizing how SCS interferes with everyday functioning is essential to validating it as a distinct diagnosable clinical entity.\u003c/p\u003e \u003cp\u003eThe study aims to fill this critical gap by investigating the association between the SCS and and subjective distress and functional impairment in key life domains. We hypothesize that:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003ePsychiatric inpatients who meet criteria for an SCS diagnosis will exhibit higher levels of distress and dysfunction than those without such a diagnosis.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eA diagnosis of SCS will independently contribute to distress and dysfunction above and beyond that attributable to other psychiatric diagnoses.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eAmong those with SCS, SCS severity, measured dimensionally, will correlate with level of distress and dysfunction across work/school, social, and family roles.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003eAs an exploratory aim, we will also assess whether specific SCS subdomains emerge as primary drivers of impairment or distress.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eParticipants\u003c/p\u003e \u003cp\u003eAs part of a larger study assessing the implementation of SCS screening in a large hospital system in New York City, a total of 218 adults were recruited from psychiatric inpatient units within 72 hours of admission between March 2024 and June 2025. Research assistants approached eligible participants during their intake process and explained the purpose and procedures of the study. After obtaining informed consent, participants completed a battery of administered and self-report measures.\u003c/p\u003e \u003cp\u003eInclusion criteria required participants to be adults (aged 18 or older) admitted to the inpatient psychiatric unit, English-speaking, and capable of providing informed consent as determined by the clinical team. Exclusion criteria included significant cognitive impairment or medical instability that would interfere with the completion of study procedures, as determined by the treating medical team on the unit.\u003c/p\u003e \u003cp\u003eThe sample had a mean age of 32.19 years (SD\u0026thinsp;=\u0026thinsp;12.82) and represented the diverse patient population served by this urban academic medical center. The study protocol was approved by the hospital\u0026rsquo;s Institutional Review Board, and all procedures adhered to ethical standards for research involving human subjects.\u003c/p\u003e \u003cp\u003eMeasures\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eSuicide Crisis Syndrome Checklist (SCS-C)\u003c/h2\u003e \u003cp\u003eThe Suicide Crisis Syndrome Checklist (SCS-C) is a clinician-administered tool rating the presence or absence of 15 symptoms grouped into the five symptom domains of SCS. A categorical diagnosis of SCS is established when at least one symptom of every domain is present. The SCS-C was designed as a brief clinical tool to diagnose SCS in healthcare settings and demonstrates good internal consistency in our current sample (α\u0026thinsp;=\u0026thinsp;.856) when retrospectively assessing symptoms present directly prior to hospitalization. The implementation of the SCS-C is currently being studied in the Mount Sinai Health System following strong results for similar brief clinician-administered SCS assessments in other healthcare settings in Chicago, Illinois (Cohen et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Karsen et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2023\u003c/span\u003e), and Pecs, Hungary Osv\u0026aacute;th et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). The SCS-C was administered via semi-structured interview by the research team. It was independently validated and showed strong reliability and validity (Bloch-Elkouby et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2025\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eRevised Suicide Crisis Inventory (SCI-2)\u003c/h3\u003e\n\u003cp\u003eThe Revised Suicide Crisis Inventory (SCI-2; Bloch-Elkouby et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) is a 61-item self-report questionnaire assessing the severity of SCS symptoms dimensionally. The SCI-2 yields a continuous score as well as subscale scores for each of the five symptom domains: entrapment, affective disturbance, cognitive dysfunction, hyperarousal, and social withdrawal. Items ask about the most severe symptoms over the past several days and are rated on a 5-point Likert scale ranging from 0 (not at all) to 4 (extremely). The scale showed strong validity and association with near-term suicide risk (Bloch-Elkouby et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) and has since been translated and validated at least 10 different countries (Chia-Yi Wu et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Park et al., \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Peper-Nascimento et al., \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). The SCI-2 was completed by participants following an intake interview administered by the research team.\u003c/p\u003e\n\u003ch3\u003eSheehan Disability Scale\u003c/h3\u003e\n\u003cp\u003eThe Sheehan Disability Scale (Sheehan et al., \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e1997\u003c/span\u003e) is a brief, validated measure of functional impairment and distress across three domains: work/school, social life, and family responsibilities. Versions of the scale have been well-validated and widely used to measure the impact of a psychiatric disorder on an individual\u0026rsquo;s recent distress and dysfunction (Arbuckle et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2009\u003c/span\u003e; Leon et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e1992\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e1997\u003c/span\u003e; Luciano et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2010\u003c/span\u003e). The scale was administered via semi-structured interview by the research team. Participants were explicitly asked about their distress and dysfunction in reference to the symptoms they experienced directly prior to hospitalization, including those endorsed on the SCS-C.\u003c/p\u003e\n\u003ch3\u003eMini-International Neuropsychiatric Interview (MINI)\u003c/h3\u003e\n\u003cp\u003eThe MINI ((Sheehan, 2016) is a structured interview designed to assess the presence of psychiatric diagnoses based on DSM and ICD criteria. This study utilized modules from the MINI 7.0 for DSM-5 (Sheehan, 2016) to assess current Major Depressive Episodes (MDE), Panic Disorder (PD), Obsessive-Compulsive Disorder (OCD), Post-Traumatic Stress Disorder (PTSD), and Psychotic Disorders. MINI diagnoses were entered as covariates in multivariate analyses to assess whether SCS predicted functional impairment or distress above and beyond other psychiatric diagnoses (Hypothesis 2).\u003c/p\u003e \u003cp\u003eData analysis plan\u003c/p\u003e \u003cp\u003eFor Hypothesis 1, to assess group differences in functional impairment and distress, independent samples t-tests compared individuals with and without a SCS diagnosis on Sheehan Disability Scale items (e.g., work/school, social life, family life disruption and distress, days lost, and days unproductive). Effect sizes were calculated using Cohen\u0026rsquo;s d (Cohen, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e1988\u003c/span\u003e). For Hypothesis 2, a series of hierarchical multiple regression models were used to evaluate the incremental validity of an SCS diagnosis above and beyond existing psychiatric diagnoses derived from the MINI. In each model, Step 1 included psychiatric diagnoses from the MINI (e.g., major depressive episode, PTSD, psychosis, OCD, panic disorder, mood disorder with psychotic features); Step 2 added the SCS-C diagnosis (yes/no). The change in explained variance (ΔR\u0026sup2;) and corresponding p-values was used to evaluate incremental validity. For Hypothesis 3, to examine the dimensional relationship between SCS symptom severity and functional outcomes, multiple linear regressions were performed among participants who met criteria for SCS on the SCS-C using the total score of the Suicide Crisis Inventory-2 (SCI-2) as a continuous predictor. Exploratory multiple regression analyses were also conducted to assess the contributions of individual SCS subdomains (e.g., affective disturbance, entrapment, social withdrawal) to each of functional impairment and distress. Composite scores were computed to reduce the number of dependent variables and limit Type I error. The disability composite was calculated as the mean of the three original SDS functioning items, and the distress composite as the mean of the three added distress items. Internal consistency of each composite was evaluated using Cronbach\u0026rsquo;s alpha (α\u0026thinsp;=\u0026thinsp;.79 and α\u0026thinsp;=\u0026thinsp;.83, respectively). A Productivity index was computed as the sum of days lost and days unproductive (α\u0026thinsp;=\u0026thinsp;.63, consistent with expectations for a 2-item scale). Significance was set at p \u0026lt; .05 for all analyses. Missing data were handled using listwise deletion for each analysis. Final sample sizes for specific analyses varied depending on the availability of complete data for outcome and predictor variables. All analyses were conducted using IBM SPSS Statistics (Version 30.0).\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eSample characteristics\u003c/h2\u003e \u003cp\u003eThe total sample consisted of 218 psychiatric inpatients (M\u003csub\u003eage\u003c/sub\u003e = 32.19, SD\u0026thinsp;=\u0026thinsp;12.82), with 49.5% identifying as female, 38% as male, and the remainder identifying as non-binary (10%), transgender (2.7%), or other (1.8%). Participants identified as White (46.3%), Black (18.8%), Asian (10.1%), Native American (2.3%), multiracial (9.6%), or other (10.5%). No significant demographic differences were found between participants with and without SCS. The mean age was similar across groups (t (216)\u0026thinsp;=\u0026thinsp;0.48, p = .635), and chi-square analyses showed no group differences in gender identity (χ\u0026sup2; (5, N\u0026thinsp;=\u0026thinsp;211)\u0026thinsp;=\u0026thinsp;4.42, p = .491) or racial identity (χ\u0026sup2; (7, N\u0026thinsp;=\u0026thinsp;217)\u0026thinsp;=\u0026thinsp;6.54, p = .478). These findings suggest that demographic variables are unlikely to account for differences in clinical outcomes (See Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cem\u003eDemographic Characteristics of the Participants\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal \u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;218)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSCS Absent \u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;62)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSCS Present \u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;156)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTest Statistic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge (years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM\u0026thinsp;=\u0026thinsp;32.19 (12.82)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eM\u0026thinsp;=\u0026thinsp;33.23 (14.49)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eM\u0026thinsp;=\u0026thinsp;31.91 (32.30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003et\u003c/em\u003e(216)\u0026thinsp;=\u0026thinsp;0.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.635\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender Identity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eχ\u0026sup2;(5, N\u0026thinsp;=\u0026thinsp;211)\u0026thinsp;=\u0026thinsp;4.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.491\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e83 (38.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24 (28.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e59 (71.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e108 (49.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34 (31.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e74 (68.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-binary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (4.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (20.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (80.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTransgender man\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (1.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (100.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTransgender woman\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (0.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (50.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (50.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (1.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (100.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRace\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eχ\u0026sup2;(7, N\u0026thinsp;=\u0026thinsp;217)\u0026thinsp;=\u0026thinsp;6.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.478\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhite\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e101 (46.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29 (28.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e72 (71.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlack\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41 (18.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (29.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29 (70.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAsian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22 (10.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (13.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19 (86.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNative American\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (2.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (20.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (80.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTwo or more races\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21 (9.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (33.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14 (66.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23 (10.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (35.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14 (64.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eFunctional Impairment and Distress Among Individuals with and without SCS\u003c/h3\u003e\n\u003cp\u003eIndividuals with an SCS diagnosis reported significantly greater distress and functional impairment across all ten domains of the Sheehan Disability Scale. The largest effects were observed for family life distress (p \u0026lt; .001, Cohen\u0026rsquo;s d\u0026thinsp;=\u0026thinsp;0.947) and social life distress (p \u0026lt; .001, d\u0026thinsp;=\u0026thinsp;0.872), followed by social life disruption (p \u0026lt;\u0026thinsp;.001, d = .858) and work/school distress (p \u0026lt;\u0026thinsp;.001, d\u0026thinsp;=\u0026thinsp;794). Individuals with SCS also reported more unproductive days or days lost due to their symptoms (p = .001 and .008 respectively) than those without SCS. These results demonstrate that SCS is associated with widespread and clinically meaningful impairment, particularly in social, family, and occupational functioning. (see Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cem\u003eComparison of Functional Impairment in 10 Sheehan Disability Scale Domains in Psychiatric Inpatients with and without SCS\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSheehan Disability Scale Item\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSCS Negative\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSCS Positive\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCohen\u0026rsquo;s d\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWork/School Disruption\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5.51 (3.54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.75 (2.49)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.779\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSocial Life Disruption\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.39 (3.48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.97 (2.78)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.858\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFamily Life Disruption\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5.04 (3.70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.10 (2.89)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.650\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDays Lost\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.25 (2.84)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.34 (2.59)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.008\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.408\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDays Unproductive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.55 (2.81)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.47 (2.68)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.705\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWork/School Distress\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.81 (3.63)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.30 (2.88)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.794\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSocial Life Distress\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.18 (3.57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.97 (3.01)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.872\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFamily Life Distress\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.35 (3.70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.24 (2.70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-0.947\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003cem\u003eNote.\u003c/em\u003e SCS as measured using the SCS-C.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eIncremental Validity of SCS Diagnosis Over Other Psychiatric Diagnoses\u003c/h2\u003e \u003cp\u003eAn SCS diagnosis accounted for significant additional distress and dysfunction beyond that attributable to MINI-based psychiatric diagnoses. The largest increases in explained variance (ΔR\u0026sup2;) were observed for family life distress (ΔR\u0026sup2; = .116, p \u0026lt; .001), work/school distress (ΔR\u0026sup2; = .068, p \u0026lt; .001), and social life distress (ΔR\u0026sup2; = .053, p \u0026lt; .001). Significant improvements in model fit were also observed for social life disruption (ΔR\u0026sup2; = .054, p \u0026lt; .001), family life disruption (ΔR\u0026sup2; = .045, p = .002), and days unproductive (ΔR\u0026sup2; = .042, p = .001). The only domain that was not significantly impacted by the addition of SCS-C was days lost (p = .115). These results demonstrate the incremental validity of SCS-C in predicting functional distress and impairment beyond standard psychiatric diagnoses (see Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cem\u003eHierarchical Regressions Assessing the Contribution of Other Diagnoses and SCS to Distress and Dysfunction in Each of 10 Domains on the Sheehan Disability Scale\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSheehan Disability Scale Item\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eR\u0026sup2;\u003c/em\u003e Step 1\u003c/p\u003e \u003cp\u003e(MINI only)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eR\u0026sup2;\u003c/em\u003e Step 2\u003c/p\u003e \u003cp\u003e(MINI\u0026thinsp;+\u0026thinsp;SCS)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eΔR\u0026sup2;\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003ep(ΔR\u0026sup2;)\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWork/School Disruption\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.239\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.306\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.068\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSocial Life Disruption\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.336\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.390\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.054\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFamily Life Disruption\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.135\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.180\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.045\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDays Lost\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.185\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.197\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.011\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.115\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDays Unproductive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.252\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.294\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.042\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWork/School Distress\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.242\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.305\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.062\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSocial Life Distress\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.306\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.360\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.053\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFamily Life Distress\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.191\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.307\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.116\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003cem\u003eNote.\u003c/em\u003e Diagnoses assessed using the M.I.N.I. and the SCS-C\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eDimensional SCS Severity (SCI-2) and Functional/Distress Outcomes\u003c/h2\u003e \u003cp\u003eSCI-2 scores of those who tested positive for SCS using the categorical SCS-C ranged between 9 and 226 with a mean of 139.4 and a standard deviation of 54.7. SCI-2 total scores were significantly associated with all Sheehan Disability Scale items among individuals with an SCS-C diagnosis (see Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). The strongest associations were with social life distress (p \u0026lt; .001, partial η\u0026sup2; = .239), family life distress (p \u0026lt; .001, partial η\u0026sup2; = .197), work/school disruption (p \u0026lt; .001, partial η\u0026sup2; = .180), and social life disruption (p \u0026lt; .001, partial η\u0026sup2; = .184). Significant but smaller effects were also found for family life disruption, days unproductive, and days lost due to existing symptoms. These findings support the hypothesis that SCI-2 severity scores are robust predictors of distress and dysfunction across life domains (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cem\u003eAssociation Between SCS severity and Sheehan Disability Scores\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSheehan Disability Scale item\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eF\u003c/em\u003e(1,df)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePartial \u003cem\u003eη\u0026sup2;\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWork/School Disruption\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e26.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.180\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSocial Life Disruption\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e29.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.184\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFamily Life Disruption\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.084\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDays Lost\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.006\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.057\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDays Unproductive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.068\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWork/School Distress\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.114\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSocial Life Distress\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e34.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.239\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFamily Life Distress\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e26.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.197\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003cem\u003eNote.\u003c/em\u003e SCS severity as measured by the SCI-2 total score\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eExploratory Analysis of SCS Subdomains\u003c/h2\u003e \u003cp\u003eTwo multiple regression models were conducted to evaluate the contributions of specific SCS subdomains (entrapment, affective disturbance, cognitive dysfunction, hyperarousal, and social withdrawal) to Sheehan disability and distress outcomes. The model predicting disability was significant, F(5, 188)\u0026thinsp;=\u0026thinsp;23.64, p \u0026lt; .001, explaining 39% of the variance (R\u0026sup2; = .39). Among the predictors, only social withdrawal was a significant positive predictor of disability (β\u0026thinsp;=\u0026thinsp;.26, p = .004). No other domains reached significance. The model predicting distress was also significant, F (5, 154)\u0026thinsp;=\u0026thinsp;17.48, p \u0026lt; .001, accounting for 36% of the variance (R\u0026sup2; = .36). Both affective disturbance (β\u0026thinsp;=\u0026thinsp;.37, p = .041) and social withdrawal (β\u0026thinsp;=\u0026thinsp;.27, p = .016) emerged as significant predictors. These findings suggest that while the SCI-2 total score remains the most robust predictor of overall impairment, individual symptom domains have different effects on various aspects of functioning and distress (See Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cem\u003eMultiple Regression of SCS Subdomains and SDS Composite Outcomes\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSCS Subdomain\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDisability composite (β)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDistress composite (β)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEntrapment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.801\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.264\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAffective disturbance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.195\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.041*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLoss of cognitive control\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.217\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.063\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHyperarousal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.875\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.640\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSocial withdrawal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.004*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.272\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.016*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003cem\u003eNote.\u003c/em\u003e Model R\u0026sup2; = .39 for Disability, .36 for Distress; *p \u0026lt;. 05\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe current study aimed to examine the relationship between SCS and functional impairment and distress in a psychiatric inpatient sample, with the goal of evaluating the clinical utility of SCS as a distinct and diagnostically meaningful construct. Individuals meeting criteria for SCS exhibited significantly greater disruption in work, social, and family domains, as well as more unproductive and lost days. The SCS-C diagnosis accounted for unique variance in impairment even after adjusting for other psychiatric diagnoses, supporting its incremental clinical value. Among those diagnosed with SCS, greater symptom severity was associated with more severe dysfunction, and exploratory analyses revealed that specific symptom clusters, particularly affective disturbance and social withdrawal were independently related to outcomes. Together, these results support SCS as a clinically meaningful construct and highlight the value of both overall syndrome severity and subdomain profiling in suicide risk assessment and intervention.\u003c/p\u003e \u003cp\u003eAcross all domains of the Sheehan Disability Scale, individuals with SCS reported significantly more impairment, with medium to large effect sizes (Cohen\u0026rsquo;s ds\u0026thinsp;=\u0026thinsp;0.33\u0026ndash;0.95). The most affected areas included family and social life, which are central to daily functioning and recovery. These findings suggest that SCS not only represents an internal psychological state, but it also reflects a breakdown in interpersonal and occupational functioning. This aligns with earlier work on the role of emotional dysregulation in acute suicidal states (Galynker et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2017\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2024\u003c/span\u003e) and expands on it by empirically demonstrating that SCS is linked to measurable real-world impairment. Even though the cross-sectional design of the study prevents determination of causality, our participants were asked the functional impairment questions explicitly in response to SCS symptoms. Clinically, this underscores the need for preventative measures, such as family-based approaches and occupational support, alongside traditional psychiatric treatment for individuals who have previously experienced or are at risk of experiencing SCS.\u003c/p\u003e \u003cp\u003eSecond, we hypothesized that SCS-C diagnosis would demonstrate incremental validity in predicting distress beyond other psychiatric diagnoses. Prior research has shown that conditions like major depressive disorder, PTSD, psychosis, and OCD are each associated with significant functional impairment across domains of daily life (Boyd et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Fulford et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2013\u003c/span\u003e; Ito et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Sahoo et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). The addition of an SCS diagnosis to these existing diagnoses in hierarchical regression significantly improved model fit across several Sheehan domains. Notably, it explained an additional 11.6% of the variance in family life distress, 6.8% in work/school distress, and 5.4% in social life disruption. These findings suggest that SCS captures an acute crisis state that is not fully explained by conventional diagnoses, supporting its utility as a diagnostic construct in its own right, reinforcing the argument for formally recognizing SCS in diagnostic manuals.\u003c/p\u003e \u003cp\u003eIn addition to categorical diagnosis, the severity of SCS, as measured dimensionally by the SCI-2, was strongly associated with all functional impairment and distress outcomes. The strongest effects were seen in interpersonal domains, including family and social life distress (partial η\u0026sup2;s = .197\u0026ndash;.239). It is notable that this effect was evident within the restricted sample of those meeting fairly conservative criteria for SCS, highlighting the value of using dimensional assessment tools like the SCI-2 to monitor symptom fluctuations over time. Clinically, SCI-2 scores could inform the need for crisis stabilization or guide discharge planning.\u003c/p\u003e \u003cp\u003eExploratory analyses revealed that affective disturbance and social withdrawal were significantly associated with overall disability and distress outcomes, which is consistent with prior research linking emotional dysregulation with interpersonal and social dysfunction (Carmassi et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). These domain-specific effects suggest that not all SCS symptoms contribute equally to impairment and that individualized preventative approaches targeting specific symptom dimensions may be most effective in alleviating the risk of developing SCS.\u003c/p\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eClinical Implications\u003c/h2\u003e \u003cp\u003eRecognizing SCS within diagnostic systems like the DSM may support earlier identification of individuals in acute suicidal crises and promote more targeted risk detection and prevention strategies. Our results, along with prior evidence demonstrating the predictive validity of SCS for suicidal outcomes (Galynker et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Bloch-Elkouby et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Parghi et al., \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2021\u003c/span\u003e), its clinical utility in risk assessment (Cohen et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2024\u003c/span\u003e, Karsen et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2023\u003c/span\u003e), and preliminary responsiveness to acute interventions (Garagiola et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2025\u003c/span\u003e), underscore its relevance in suicide prevention. Given the significant functional disruption observed, including occupational impairment and family-associated distress, integrating assessments of functional impairment into suicide risk evaluations may enhance clinical decision-making and facilitate crisis prevention.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eLimitations and Future Directions\u003c/h2\u003e \u003cp\u003eSeveral limitations should be considered when interpreting these results. The cross-sectional design limits conclusions about the direction of the relationship between SCS symptoms and functional impairment. The sample was exclusively drawn from the inpatient unit which may limit generalizability to community populations experiencing less severe crises. The use of both self-report and researcher-administered measures may have possibly alleviated the potential responses biases associated with self-report measures. Additionally, while we controlled for several covariates, unmeasured factors like comorbid medical conditions or individual psychosocial stressors may influence the observed relationships.\u003c/p\u003e \u003cp\u003eFuture research should address these limitations through longitudinal designs that track functional changes throughout SCS episodes and recovery. Studies comparing inpatient and outpatient populations could clarify whether impairment patterns differ by crisis severity. Research examining whether functional improvement mediates reduced suicide risk could inform treatment approaches.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study strengthens the empirical basis for the SCS as a clinically valid construct by demonstrating its strong association with daily functioning. Individuals with SCS reported significantly greater impairment, and symptom severity emerged as a robust predictor of distress across all functional areas, with subdomain analyses revealing unique contributions such as emotional disturbance to family life disruption, and social withdrawal to familial distress. These results highlight the utility of assessing SCS severity and symptom profiles in clinical settings to guide targeted interventions. Future research should prioritize developing preventative measures that would mitigate the specific functional impairments linked to SCS, aiming to reduce both acute suicide risk and longer-term disability.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eData availability: The datasets used for the current study are not publicly available due to patient confidentiality but are available from the corresponding author on reasonable request and with appropriate institutional approvals.\u003c/p\u003e\n\u003cp\u003eFunding: This work was supported by the American Foundation for Suicide Prevention under grant #TBT-1-136-22 (PI: Igor Galynker, MD, PhD).\u003c/p\u003e\n\u003cp\u003eConflict of interest disclosure: The authors declare that they have no conflicts of interest relevant to this manuscript.\u003c/p\u003e\n\u003cp\u003eEthics approval: The study was conducted in accordance with the Declaration of Helsinki and approved by the Institutional Review Board of the Icahn School of Medicine at Mount Sinai (Protocol #23-00911).\u003c/p\u003e\n\u003cp\u003ePatient consent: Written informed consent was obtained from all participants prior to participation.\u003c/p\u003e\n\u003cp\u003eClinical trial number: Not applicable\u003c/p\u003e\n\u003cp\u003ePermission to reproduce material from other sources: No previously published material was reproduced in this manuscript.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eR.E. conceived the study, conducted the formal statistical analyses, and drafted the initial manuscript.E.W. and B.P. contributed to manuscript drafting and substantive intellectual content.B.P. prepared and formatted all tables.T.U. managed the references and contributed to general manuscript editing.S.B.E. and L.J.C. critically reviewed the manuscript and provided important revisions for intellectual content.I.G. supervised the study, provided overall conceptual guidance, and oversaw all stages of the research and manuscript preparation.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThis work was supported by the American Foundation for Suicide Prevention (Grant #TBT-1-136-22; PI: Igor Galynker, MD, PhD)\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAmerican Psychiatric Association. 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PMID: 35441411.\u003c/li\u003e\n\u003cli\u003eRogers ML, McMullen L, Liang Y, Perez N, Richards JA, Ak\u0026uuml;lker G, Barzilay S, Bilici R, Blum Y, Chistopolskaya K, Dudeck M, Husain MI, Kuśmirek O, Luiz JM, Menon V, Pilecka B, Sadovnichaya V, Titze L, Valvassori SS, You S, Galynker I. Cross-national presence and sociodemographic correlates of the suicide crisis syndrome. J Affect Disord. 2023 May 15;329:1-8. doi: 10.1016/j.jad.2023.02.076. Epub 2023 Feb 23. PMID: 36828142.\u003c/li\u003e\n\u003cli\u003eRogers, M. L., Richards, J. A., Cao, E., Krumerman, M., Barzilay, S., Blum, Y., Chistopolskaya, K., \u0026Ccedil;inka, E., Dudeck, M., Husain, M. I., Yilmaz, F. K., Kravtsova, N. A., Kuśmirek, O., Menon, V., Peper-Nascimento, J., Pilecka, B., Titze, L., Valvassori, S. S., You, S., \u0026amp; Galynker, I. (2023). 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(2016, August 8). \u003cem\u003eM.I.N.I. MINI INTERNATIONAL NEUROPSYCHIATRIC INTERVIEW\u003c/em\u003e. https://pdf.medenshealth.com/MINI-Standard.pdf\u003c/li\u003e\n\u003cli\u003eSheehan, D., Lecrubier, Y., Harnett Sheehan, K., Janavs, J., Weiller, E., Keskiner, A., Schinka, J., Knapp, E., Sheehan, M., \u0026amp; Dunbar, G. (1997). The validity of the Mini International Neuropsychiatric Interview (MINI) according to the SCID-P and its reliability. \u003cem\u003eEuropean Psychiatry\u003c/em\u003e, \u003cem\u003e12\u003c/em\u003e(5), 232\u0026ndash;241. https://doi.org/10.1016/S0924-9338(97)83297-X\u003c/li\u003e\n\u003cli\u003eWoodford, R., Spittal, M. J., Milner, A., McGill, K., Kapur, N., Pirkis, J., Mitchell, A., \u0026amp; Carter, G. (2019). Accuracy of Clinician Predictions of Future Self‐Harm: A Systematic Review and Meta‐Analysis of Predictive Studies. \u003cem\u003eSuicide and Life-Threatening Behavior\u003c/em\u003e, \u003cem\u003e49\u003c/em\u003e(1), 23\u0026ndash;40. https://doi.org/10.1111/sltb.12395\u003c/li\u003e\n\u003cli\u003eWorld Health Organization. (2025, March 25). \u003cem\u003eSuicide\u003c/em\u003e. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/suicide\u003c/li\u003e\n\u003cli\u003eYaseen, Z. S., Hawes, M., Barzilay, S., \u0026amp; Galynker, I. (2019). Predictive Validity of Proposed Diagnostic Criteria for the Suicide Crisis Syndrome: An Acute Presuicidal State. \u003cem\u003eSuicide and Life-Threatening Behavior\u003c/em\u003e, \u003cem\u003e49\u003c/em\u003e(4), 1124\u0026ndash;1135. https://doi.org/10.1111/sltb.12495\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-psychiatry","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bpsy","sideBox":"Learn more about [BMC Psychiatry](http://bmcpsychiatry.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bpsy/default.aspx","title":"BMC Psychiatry","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Suicide Crisis Syndrome, Functional Impairment, Distress, Suicide prevention","lastPublishedDoi":"10.21203/rs.3.rs-8843649/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8843649/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThe Suicide Crisis Syndrome (SCS) is a proposed diagnostic construct designed to identify individuals at imminent risk for suicide, characterized by feelings of entrapment, affective disturbance, cognitive dyscontrol, hyperarousal, and social withdrawal. For a disorder to be included in the Diagnostic and Statistical Manual of Mental Disorders (DSM), it must be associated with clinically significant distress or functional impairment across major life domains. This study examined the relationship between SCS and both distress and functional impairment in a psychiatric inpatient sample to assess its clinical significance and potential DSM inclusion.\u003c/p\u003e \u003cp\u003eA total of 218 psychiatric inpatients completed the clinician-administered SCS Checklist (SCS-C), the self-report Suicide Crisis Inventory-2 (SCI-2), and the Sheehan Disability Scale. Psychiatric diagnoses were determined using the Mini International Neuropsychiatric Interview (MINI). Analyses included independent samples t-tests, hierarchical regression, and multiple regressions.\u003c/p\u003e \u003cp\u003eParticipants meeting diagnostic criteria for SCS reported significantly greater impairment and distress across all Sheehan domains (Cohen\u0026rsquo;s ds\u0026thinsp;=\u0026thinsp;0.33\u0026ndash;0.95). Hierarchical regressions showed that SCS accounted for additional variance in functional impairment beyond other psychiatric diagnoses (ΔR\u0026sup2; = .042\u0026ndash;.116, ps \u0026le; .002), particularly in family and social functioning. Among individuals with SCS, higher SCI-2 scores were associated with greater distress and impairment (partial η\u0026sup2; = .057\u0026ndash;.239), with affective disturbance and social withdrawal emerging as primary contributors.\u003c/p\u003e \u003cp\u003eThese findings demonstrate that SCS, measured both categorically and dimensionally, is linked to clinically significant distress and impairment across work, social, and family domains, providing empirical support for its potential recognition as a DSM disorder.\u003c/p\u003e","manuscriptTitle":"Assessing Functional Impairment and Distress Associated with the Suicide Crisis Syndrome in Psychiatric Inpatients","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-19 18:29:02","doi":"10.21203/rs.3.rs-8843649/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-04-16T12:05:52+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-08T09:23:46+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"295341775054456700839538313266886855000","date":"2026-03-19T17:22:55+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-12T13:14:15+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"263658348467031745489667275579179477366","date":"2026-02-19T09:21:55+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-16T13:55:57+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-02-13T09:54:34+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-12T05:06:26+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-12T05:02:33+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Psychiatry","date":"2026-02-10T16:05:44+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-psychiatry","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bpsy","sideBox":"Learn more about [BMC Psychiatry](http://bmcpsychiatry.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bpsy/default.aspx","title":"BMC Psychiatry","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"114a8eea-5a03-4d9a-8fbc-c32006296239","owner":[],"postedDate":"February 19th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-04-16T12:23:24+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-19 18:29:02","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8843649","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8843649","identity":"rs-8843649","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}