Suicide rating scale offers insights into intent, actions of patients

A suicide assessment exam that quantifies suicidal ideation and suicidal behavior as distinct domains instead of a continuum of behavior is suitable for clinical use, a new study concluded.

The Columbia-Suicide Severity Rating Scale (C-SSRS) (available online) was designed to quantify the severity of suicidal ideation and behavior. To assess C-SSRS's validity compared to other measures of suicidal ideation and behavior, as well as the exam's internal consistency, researchers applied data from three previous studies:

• a National Institute of Mental Health multisite study of 124 adolescents with a suicide attempt or interrupted attempt 90 days before enrollment;
• an industry-sponsored multisite, double blind, placebo-controlled, parallel-group, fixed-dose clinical trial to evaluate the efficacy of escitalopram relative to placebo in the treatment of major depressive disorder among 312 adolescents with a diagnosis of major depressive disorder; and
• a study funded by the American Foundation for Suicide Prevention that evaluated the identification and classification of recent suicide attempts and nonsuicidal self-injurious behavior among 237 adults who presented to an emergency department for psychiatric reasons.

Results were published online Nov. 8 by The American Journal of Psychiatry.

The authors found that the C-SSRS demonstrated good convergent and divergent validity with other suicidal ideation and behavior scales and had high sensitivity and specificity for suicidal behavior classifications compared with other assessment scales. Its ideation and behavior subscales were sensitive to change over time, the authors noted, and the intensity of ideation subscale demonstrated moderate to strong internal consistency.

Other important findings included the following:

• The C-SSRS severity subscale is sensitive to clinical change. Similarly, the C-SSRS identified almost an identical number of cases with specific types of suicidal behavior as the Columbia Suicide History Form and the suicide evaluation board ratings in study 1.
• The C-SSRS demonstrated predictive validity, while another scoring system for suicidal ideation did not predict near-term nonfatal suicidal behavior.
• A history of severe ideation with at least some intent to die may confer a greater risk for suicidal behavior than a history of ideation with no intent to die.

The authors wrote, “Establishing clinically meaningful thresholds that indicate heightened suicide risk and predict which individuals will go on to engage in suicidal behavior have been elusive in efforts at suicide prevention. Because ideation severity can be used to set criteria for clinical referral and inclusion or exclusion criteria in research, operationalization of clinical thresholds could facilitate enrollment of patients with suicidal behavior in research studies, as well as clinical management more broadly.”