Direct comparison of the psychometric properties of multiple interview and patient-rated asessments of suicidal ideation and behavior in an adult psychiatric inpatient sample

Youngstrom, E. A. and Hameed, A. and Mitchell, M. and Van Meter, A. and Freeman, A. J. and Perez Algorta, Guillermo and White, A. and Clayton, P. and Gelenberg, A. and Meyer, R. E. (2015) Direct comparison of the psychometric properties of multiple interview and patient-rated asessments of suicidal ideation and behavior in an adult psychiatric inpatient sample. Journal of Clinical Psychiatry, 76 (12). pp. 1676-1682. ISSN 0160-6689

Abstract

Objective: Compare the accuracy, agreement, internal consistency, and inter-rater reliability of three interviews to assess suicidal ideation and behavior in accordance with FDA guidance about reporting categories. Method: Adults admitted to a psychiatric inpatient unit (N=199) completed three assessments of past month and lifetime suicidal ideation and behavior–the Columbia Suicide Severity Rating Scale (C-SSRS), the Suicide Tracking Scale (STS) and the Sheehan Suicidality Tracking Scale (S-STS) in randomized, counterbalanced order. “Missing gold standard” latent class analyses defined categories for ideation and behavior. Analyses also evaluated the S-STS mapping to C-SSRS categories. Three trained judges re-rated 89 randomly selected interview videotapes. Kappa quantified agreement above chance. Data were collected between November/2011 to June/2013. Results: All three assessments showed excellent accuracy for suicidal ideation (kappas=0.72 to 1.00) and attempts (kappas=0.82 to 0.95) calibrated against latent classes. Inter-rater agreement ranged from kappa=0.62 to 1.00. Inter-rater agreement about more granular C-SSRS categories varied more widely (kappas=0.48 to 1.00), and the C-SSRS and S-STS assigned significantly different numbers of cases to many categories. Cronbach’s alpha was <0.55 for the C-SSRS ideation and between 0.80 and 0.92 for the other scales. Conclusion: All three assessments showed good accuracy for broad categories of suicidal ideation and behavior. More granular, specific categories usually were rated reliably, but the C-SSRS and S-STS differed significantly in assigning patients to several fine-grained categories. Using any of these interviews would improve reliability in assessing suicidal ideation and behavior. Clinical predictive validity of these interviews, and particularly the more granular categories, remains to be shown.