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Pollak OH, Sheehan AE, Walsh RFL, Stephenson AR, Zell H, Mayes J, Lawrence HR, Bettis AH, Liu RT. Assessment of suicidal thoughts and behaviors in adults: A systematic review of measure psychometric properties and implications for clinical and research utility. Clin Psychol Rev 2024; 112:102464. [PMID: 39106741 DOI: 10.1016/j.cpr.2024.102464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 06/12/2024] [Accepted: 07/06/2024] [Indexed: 08/09/2024]
Abstract
High-quality clinical care and research on suicidal thoughts and behaviors (STBs) depends on availability and implementation of reliable and valid measures of STBs. In contrast to studies examining STB risk factors, screening instruments, or treatment, little research has rigorously examined the content, characteristics, and psychometric properties of STB measures themselves. This systematic review (1) identified STB measures that conform to empirically supported definitions of STBs, and (2) identified peer-reviewed papers reporting on the psychometric properties of these measures in adults. Data on psychometric properties and other measure characteristics were extracted. A total of 21 eligible measures were identified in the first stage. In the second stage, 70 articles (with 79 independent samples) were included with psychometric data in adult samples for 19 measures. Although there was support for strong internal consistency and content validity across many measures, face validity and clinical utility concerns were prevalent. Few measures comprehensively assessed suicidal behaviors, and interview-based assessments tended to show the strongest psychometric properties and clinical utility. Findings are discussed in the context of recommendations for improving existing measures, including future research to increase utility and translatability across clinical settings, delivery methods, and diverse populations.
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Affiliation(s)
- Olivia H Pollak
- Department of Psychology and Neuroscience, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Ana E Sheehan
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE, USA
| | - Rachel F L Walsh
- Department of Psychology and Neuroscience, Temple University, Philadelphia, PA, USA
| | - Auburn R Stephenson
- Department of Psychology and Neuroscience, Temple University, Philadelphia, PA, USA
| | - Holly Zell
- School of Psychological Science, Oregon State University, Corvallis, OR, USA
| | - Jenna Mayes
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Alexandra H Bettis
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Richard T Liu
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
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Liu RT, Bettis AH, Lawrence HR, Walsh RFL, Sheehan AE, Pollak OH, Stephenson AR, Kautz MM, Marlowe RM. Measures of Suicidal Thoughts and Behaviors in Children and Adolescents: A Systematic Review and Recommendations for Use in Clinical and Research Settings. Assessment 2024:10731911241249438. [PMID: 38742801 DOI: 10.1177/10731911241249438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
Empirically supported measures of suicidal thoughts and behaviors (STBs) are needed to serve as reference outcomes for suicide risk screening tools and to monitor severity and treatment progress in children and adolescents with STBs. The present paper systematically reviewed existing measures of STBs in youth and studies evaluating their psychometric properties and clinical utility. Measures were then evaluated on reliability, validity, and clinical utility. Sixteen articles (20 independent samples) were found with psychometric data with youth samples for eight measures. Interview-based measures were found to have the strongest psychometric support and clinical utility. Significant limitations exist for all self-report measures due to inherent characteristics of these measures that cannot be remedied through additional psychometric study. There is an urgent need for the development and validation of new self-report measures of STBs, particularly for preadolescent children, sexual and gender minority youth, and racial/ethnic minority youth.
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Affiliation(s)
- Richard T Liu
- Massachusetts General Hospital, Boston, USA
- Harvard Medical School, Boston, MA, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
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Al-Imam A, Motyka MA, Hoffmann B, Al-Ka’aby H, Younus M, Al-Hemiary N, Michalak M. Risk Factors of Suicidal Ideation in Iraqi Crystal Methamphetamine Users. Brain Sci 2023; 13:1279. [PMID: 37759880 PMCID: PMC10526952 DOI: 10.3390/brainsci13091279] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 08/29/2023] [Accepted: 08/30/2023] [Indexed: 09/29/2023] Open
Abstract
Crystal methamphetamine, a potent psychostimulant, presents a complex clinical landscape. However, insights into the predisposing factors for suicidal tendencies among Iraqi users remain limited. Our study delves into these risks among 165 patients. Rigorous multivariable analysis was conducted, employing binary logistic regression, drawing from patients from Baghdad Medical City and Ibn-Rushd Teaching Hospital. Most participants were in their third decade (26.62 ± 0.53 years). Regarding suicidal ideation, our model demonstrated robust accuracy, supported by the Hosmer-Lemeshow goodness-of-fit test (NagelKerke's R2 = 0.49, accuracy = 79.4%, p = 0.885). Notably, chronic methamphetamine use exceeding a year (OR = 6.15, p = 0.001), absence of psychological trauma (OR = 4.58, p = 0.006), and incidence of visual hallucinations (OR = 4.52, p = 0.001) rendered users more susceptible to suicidal ideation. Furthermore, our investigation unveiled risk factors tied to psychotic features and withdrawal manifestations. The study underscores pivotal predictors of suicidal ideation, warranting interdisciplinary vigilance from psychiatrists, clinical psychologists, and social workers. By monitoring at-risk individuals, progression toward the intricate spectrum of suicide can be potentially averted. These findings illuminate the urgency of tailored interventions for crystal methamphetamine users, contributing to enhanced holistic care.
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Affiliation(s)
- Ahmed Al-Imam
- Department of Computer Science and Statistics, Doctoral School, Poznan University of Medical Sciences, 61-806 Poznan, Poland
- Department of Anatomy and Cellular Biology, College of Medicine, University of Baghdad, Baghdad 10047, Iraq
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AD, UK
| | - Marek A. Motyka
- Institute of Sociological Sciences, University of Rzeszow, 35-959 Rzeszów, Poland;
| | - Beata Hoffmann
- Institute of Applied Social Sciences, University of Warsaw, 00-927 Warsaw, Poland;
| | - Hussein Al-Ka’aby
- Department of Psychiatry, Baghdad Medical City Teaching Complex, Baghdad 10047, Iraq; (H.A.-K.); (N.A.-H.)
| | - Manal Younus
- Iraqi Pharmacovigilance Centre, Ministry of Health, Baghdad 10047, Iraq;
- The Middle East Chapter, The International Society of Pharmacovigilance (ISoP), London SW12 0HS, UK
- Council for International Organizations of Medical Sciences (CIOMS), 1218 Geneva, Switzerland
| | - Nesif Al-Hemiary
- Department of Psychiatry, Baghdad Medical City Teaching Complex, Baghdad 10047, Iraq; (H.A.-K.); (N.A.-H.)
- Department of Psychiatry, College of Medicine, University of Baghdad, Baghdad 10047, Iraq
- Psychiatry Council, The Iraqi Board for Medical Specializations, Baghdad 10047, Iraq
| | - Michal Michalak
- Department of Computer Science and Statistics, Poznan University of Medical Sciences, 61-806 Poznan, Poland;
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Powsner S, Goebert D, Richmond JS, Takeshita J. Suicide Risk Assessment, Management, and Mitigation in the Emergency Setting. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2023; 21:8-17. [PMID: 37205029 PMCID: PMC10172543 DOI: 10.1176/appi.focus.20220072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Suicide is a serious public health issue and is a leading cause of death worldwide. Suicidal ideation is a common presentation in emergency department (ED) settings, with many nuanced complications. Therefore, understanding screening, assessment, and mitigation is paramount to successful encounters with individuals presenting to emergency settings in psychiatric crises. Screening helps to identify the few people at risk within a large group. Assessment seeks to decide whether a specific individual is at significant risk. Mitigation aims to reduce the risk of suicide or of a serious attempt for a person at risk. These aims cannot be achieved with perfect reliability, but some approaches are more effective than others. Suicide screening specifics are important, even to individual practitioners, because a positive screen triggers assessment. Most practitioners understand assessment well: beginning with early psychiatric training, they are taught signs and symptoms suggesting that a patient might be at risk of suicide. Mitigating suicide risk is increasingly important to reduce the misery of ED boarding for patients awaiting psychiatric admission. For many patients, hospital admission is unnecessary if support, monitoring, and contingency plans are workable. For any individual patient, there may be a complicated mix of findings, risks, and interventions. Evidence-based screening and assessment tools are inadequate for the possible complexities, making care of individual patients dependent on good clinical assessment. The authors review the available evidence and offer experienced recommendations for challenges not yet thoroughly researched.
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Affiliation(s)
- Seth Powsner
- Department of Psychiatry and Department of Emergency Medicine, Yale University School of Medicine, Yale New Haven Hospital, New Haven, Connecticut (Powsner); Department of Psychiatry, John A. Burns School of Medicine (Goebert, Takeshita), and Office of Public Health Studies (Goebert), University of Hawaii, Honolulu; Department of Psychiatry, Tufts University School of Medicine, Tufts University, Medford, Massachusetts, and Jamaica Plain Department of Veterans Affairs (VA) Medical Center, VA Boston Health Care System, Boston (Richmond); Department of Psychiatry, Queen's Medical Center, Honolulu (Goebert, Takeshita)
| | - Deborah Goebert
- Department of Psychiatry and Department of Emergency Medicine, Yale University School of Medicine, Yale New Haven Hospital, New Haven, Connecticut (Powsner); Department of Psychiatry, John A. Burns School of Medicine (Goebert, Takeshita), and Office of Public Health Studies (Goebert), University of Hawaii, Honolulu; Department of Psychiatry, Tufts University School of Medicine, Tufts University, Medford, Massachusetts, and Jamaica Plain Department of Veterans Affairs (VA) Medical Center, VA Boston Health Care System, Boston (Richmond); Department of Psychiatry, Queen's Medical Center, Honolulu (Goebert, Takeshita)
| | - Janet S Richmond
- Department of Psychiatry and Department of Emergency Medicine, Yale University School of Medicine, Yale New Haven Hospital, New Haven, Connecticut (Powsner); Department of Psychiatry, John A. Burns School of Medicine (Goebert, Takeshita), and Office of Public Health Studies (Goebert), University of Hawaii, Honolulu; Department of Psychiatry, Tufts University School of Medicine, Tufts University, Medford, Massachusetts, and Jamaica Plain Department of Veterans Affairs (VA) Medical Center, VA Boston Health Care System, Boston (Richmond); Department of Psychiatry, Queen's Medical Center, Honolulu (Goebert, Takeshita)
| | - Junji Takeshita
- Department of Psychiatry and Department of Emergency Medicine, Yale University School of Medicine, Yale New Haven Hospital, New Haven, Connecticut (Powsner); Department of Psychiatry, John A. Burns School of Medicine (Goebert, Takeshita), and Office of Public Health Studies (Goebert), University of Hawaii, Honolulu; Department of Psychiatry, Tufts University School of Medicine, Tufts University, Medford, Massachusetts, and Jamaica Plain Department of Veterans Affairs (VA) Medical Center, VA Boston Health Care System, Boston (Richmond); Department of Psychiatry, Queen's Medical Center, Honolulu (Goebert, Takeshita)
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Veloso LUP, Monteiro CFDS, Santos JC. CONTENT VALIDATION FOR THE BRAZILIAN VERSION OF THE NURSES GLOBAL ASSESSMENT OF SUICIDE RISK INDEX. TEXTO & CONTEXTO ENFERMAGEM 2021. [DOI: 10.1590/1980-265x-tce-2019-0330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Objective: to perform the content validation of the Nurses Global Assessment of Suicide Risk index for the Brazilian population served in primary care. Method: a methodological study of cultural adaptation and content evaluation of the NGASR index, original scale from the United Kingdom, carried out through the stages: evaluation of verbal comprehension by an experts committee (semantic, idiomatic, conceptual and cultural equivalence and content validity), back-translation and verification of clarity by means of a pre-test. The experts committee was composed of nine judges and the pre-test with 30 users of primary care services and 19 nurses. The Content Validation Index was calculated. Results: the final validated version is composed of 15 items that obtained a Content Validation Index greater than 0.78 by the experts committee and in the application of the pre-test with users and nurses. Conclusion: the instrument favors the performance of professional nurses in primary health care in the prevention of suicidal behavior by facilitating risk assessment and the adoption of relevant actions.
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Sousa MDCVB, Fernandes BD, Foppa AA, Almeida PHRF, Mendonça SDAM, Chemello C. Tools to prioritize outpatients for pharmaceutical service: A scoping review. Res Social Adm Pharm 2020; 16:1645-1657. [DOI: 10.1016/j.sapharm.2020.02.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 02/07/2020] [Accepted: 02/18/2020] [Indexed: 01/16/2023]
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Is a brief self-report version of the Columbia severity scale useful for screening suicidal ideation in Chilean adolescents? Compr Psychiatry 2019; 88:39-48. [PMID: 30471550 DOI: 10.1016/j.comppsych.2018.11.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 10/11/2018] [Accepted: 11/03/2018] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Given the high rates of suicide in the adolescent population and the reluctance of this population to seek help, developing proactive and effective strategies to timely detect individuals at high risk for suicide in non-clinical contexts is a worldwide recognized need. A series of brief self-report questionnaires have been developed for this purpose, however there are few studies providing evidence on their capability to accurately classify suicidal risk levels in specific populations. One of the instruments frequently used to evaluate suicide risk is the Columbia-Suicide Severity Rating Scales (C-SSRS). The goal of this study is to provide psychometric evidence about the accuracy of the Suicidal Ideation subscale (SI) of the C-SSRS to classify suicidal risk levels in a sample of Chilean adolescents using Item Response Theory (IRT). METHODS AND MATERIALS Through the two parameter logistic model (2-PLM), we analyzed the capability of a self-report questionnaire addressing suicidal ideation (SI) to differentiate and classify participants according to their SI severity levels. We tested two main parameters: difficulty (localization) and discriminating power of 6 items extracted and adapted from the Columbia-Suicide Severity Rating Scales (C-SSRS). We administered this questionnaire to a general sample of 1645 adolescents aged 13 to 18. RESULTS Our results show that the items differentiate symptoms addressing suicidal thoughts according to their severity, providing an accurate classification of the SI risk level. CONCLUSIONS These findings support the usage of the C-SSRS in Chilean adolescents. Further research is needed to test its predictive value in different populations.
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Ventosa Brás MS, Guerreiro Carmo CI, de Jesus SN. Reasons for Living Inventory for Adolescents: Psychometric Properties Among Portuguese Adolescents. OMEGA-JOURNAL OF DEATH AND DYING 2018; 82:527-547. [PMID: 30577719 DOI: 10.1177/0030222818819340] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Reasons for living are protective factors against suicidal behavior in adolescents. One of the most useful measures to assess them is the Reasons for Living Inventory for Adolescents (RFL-A) developed by Osman et al. The goal of this study was to examine the psychometric properties of its Portuguese version of the RFL-A. To this end, we recruited 512 high school adolescents (mean age = 16.7 years), who completed the RFL-A, a Suicidal Ideation Questionnaire, and a hopelessness scale. Exploratory factor analysis replicated the original five-factor model and confirmatory factor analysis obtained satisfactory adjustment values. The RFL-A shows good reliability (internal consistency and temporal stability) as well as good convergent, discriminant, and concurrent validities. These results indicate that the RFL-A is a valid and reliable measure to study protective factors against suicidal behaviors in Portuguese adolescents.
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Affiliation(s)
- Marta Sofia Ventosa Brás
- Psychology and Educational Department, Faculty of Human and Social Sciences, University of the Algarve, Faro, Portugal
| | | | - Saul Neves de Jesus
- Psychology and Educational Department, Faculty of Human and Social Sciences, University of the Algarve, Faro, Portugal
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Plöderl M, Kunrath S, Cramer RJ, Wang J, Hauer L, Fartacek C. Sexual orientation differences in treatment expectation, alliance, and outcome among patients at risk for suicide in a public psychiatric hospital. BMC Psychiatry 2017; 17:184. [PMID: 28506219 PMCID: PMC5433065 DOI: 10.1186/s12888-017-1337-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 04/27/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sexual minority (SM) individuals (gay, lesbian, bisexual, or otherwise nonheterosexual) are at increased risk for mental disorders and suicide and adequate mental healthcare may be life-saving. However, SM patients experience barriers in mental healthcare that have been attributed to the lack of SM-specific competencies and heterosexist attitudes and behaviors on the part of mental health professionals. Such barriers could have a negative impact on common treatment factors such as treatment expectancy or therapeutic alliance, culminating in poorer treatment outcomes for SM versus heterosexual patients. Actual empirical data from general psychiatric settings is lacking, however. Thus, comparing the treatment outcome of heterosexual and SM patients at risk for suicide was the primary aim of this study. The secondary aim was to compare treatment expectation and working alliance as two common factors. METHODS We report on 633 patients from a suicide prevention inpatient department within a public psychiatric hospital. Most patients were at risk for suicide due to a recent suicide attempt or warning signs for suicide, usually in the context of a severe psychiatric disorder. At least one indicator of SM status was reported by 21% of patients. We assessed the treatment outcome by calculating the quantitative change in suicide ideation, hopelessness, and depression. We also ran related treatment responder analyses. Treatment expectation and working alliance were the assessed common factors. RESULTS Contrary to the primary hypothesis, SM and heterosexual patients were comparable in their improvement in suicide ideation, hopelessness, or depression, both quantitatively and in treatment responder analysis. Contrary to the secondary hypothesis, there were no significant sexual orientation differences in treatment expectation and working alliance. When adjusting for sociodemographics, diagnosis, and length of stay, some sexual orientation differences became significant, indicating that SM patients have better outcomes. CONCLUSIONS These unexpected but positive findings may be due to common factors of therapy compensating for SM-specific competencies. It may also be due to actual presence of SM competencies - though unmeasured - in the department. Replication in other treatment settings and assessment of SM-specific competencies are needed, especially in the field of suicide prevention, before these findings can be generalized.
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Affiliation(s)
- Martin Plöderl
- Department for Crisis Intervention and Suicide Prevention, Christian Doppler Clinic, Paracelsus Medical University, Ignaz Harrerstrasse 79, A-5020, Salzburg, Austria. .,Department of Clinical Psychology, Christian Doppler Clinic, Paracelsus Medical University, Salzburg, Austria.
| | - Sabine Kunrath
- 0000 0004 0523 5263grid.21604.31Department for Crisis Intervention and Suicide Prevention, Christian Doppler Clinic, Paracelsus Medical University, Ignaz Harrerstrasse 79, A-5020 Salzburg, Austria
| | - Robert J. Cramer
- 0000 0001 2164 3177grid.261368.8School of Community and Environmental Health Sciences, Old Dominion University, Norfolk, Virginia USA ,Virginia Consortium Program in Clinical Psychology, Norfolk, Virginia USA
| | - Jen Wang
- 0000 0001 0423 4662grid.8515.9Interdisciplinary Division for Adolescent Health, Department of Pediatrics, Lausanne University Hospital, Lausanne, Switzerland
| | - Larissa Hauer
- 0000 0004 0523 5263grid.21604.31Department for Crisis Intervention and Suicide Prevention, Christian Doppler Clinic, Paracelsus Medical University, Ignaz Harrerstrasse 79, A-5020 Salzburg, Austria
| | - Clemens Fartacek
- 0000 0004 0523 5263grid.21604.31Department for Crisis Intervention and Suicide Prevention, Christian Doppler Clinic, Paracelsus Medical University, Ignaz Harrerstrasse 79, A-5020 Salzburg, Austria ,0000 0004 0523 5263grid.21604.31Department of Clinical Psychology, Christian Doppler Clinic, Paracelsus Medical University, Salzburg, Austria
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