The 9-item Concise Health Risk Tracking - Self-Report (CHRT-SR9) measure of suicidal risk: Performance in adult primary care patients

Evidence-based guidelines for the interpretation of the 9-item Concise Health Risk Tracking - Self-Report (CHRT-SR9) measure of suicidal risk

BACKGROUND

The 9-item Concise Health Risk Tracking - Self-Report (CHRT-SR9) is a widely used patient-reported outcome measure of suicidal risk. The goal of this article is to provide an evidence-based interpretation of the CHRT-SR9 total score in terms of four clinically actionable categories of suicidal risk (none, mild, moderate, and severe).

METHODS

Data from two large programs involving adolescents and adults were combined in this paper. In these studies, the CHRT-SR9 was anchored against an independent measure of suicidal risk, the suicide item (Item #9) in the Patient Health Questionnaire (PHQ-9), with categories 0 (none), 1 (mild), 2 (moderate), and 3 (severe). In the combined data (n = 1945), we calculated the cumulative percentage of data across these four categories and the percentile score of the CHRT-SR9 total score that corresponded to these percentages; from this, we developed ranges of the CHRT-SR9 total score that corresponded to the four categories of Item #9 of PHQ-9. We also calculated similar ranges for two broad subscales of the CHRT-SR9 total score; Propensity and Suicidal Thoughts. To assess the robustness of our findings, we repeated the analysis at another timepoint across studies.

RESULTS

Findings indicated that the CHRT-SR9 total score (range: 0-36) can be categorized as none (0-14), mild (15-21), moderate (22-26), and severe (27-36). Similar categories were calculated for the Propensity and Suicidal Thoughts subscales. The findings were the same when repeated at another timepoint.

CONCLUSION

This categorization of the CHRT-SR9 total score can place patients into clinically meaningful and actionable categories of suicidal risk.

Assessment of suicidal thoughts and behaviors in adults: A systematic review of measure psychometric properties and implications for clinical and research utility

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.

Measurement Choices for Youth Suicidality

Suicide is among the leading causes of death among individuals ages 10-24, making suicidal thoughts and behaviors (STBs) a serious public health crisis among youth. Suicide risk screening and assessment are vital to addressing this public health crisis. In fact, many youths that screen positive for suicidal ideation do not have known mental health concerns and would have been missed if not asked directly. Medical settings are an optimal setting to detect suicidality early and provide appropriate follow-up monitoring and care as needed. To support effective and efficient screening and assessment of suicidal thoughts and behaviors, providers must choose measures with both strong psychometric properties and clinical utility. While measurement of STBs can vary across health settings, suicide risk screening and assessment typically involves gathering information about current suicidal ideation, suicidal behaviors, and suicidal plans via self-report questionnaires, clinical interviews, and/or computerized adaptive screens. In alignment with measurement-based care efforts, the current manuscript will provide a scoping review of measures of youth suicidal ideation, behavior, plans, and their risk factors. Specifically, the psychometric properties, clinical utility, and other key considerations for screening and assessment of adolescent suicide risk are discussed.