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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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Busby DR, Hughes JL, Walters M, Ihediwa A, Adeniran M, Goodman L, Mayes TL. Measurement Choices for Youth Suicidality. Child Psychiatry Hum Dev 2023:10.1007/s10578-023-01627-5. [PMID: 38147138 DOI: 10.1007/s10578-023-01627-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/27/2023] [Indexed: 12/27/2023]
Abstract
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.
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Affiliation(s)
- Danielle R Busby
- Department of Psychiatry and Behavioral Sciences, University of Texas Medical Branch, Galveston, USA.
| | - Jennifer L Hughes
- Department of Psychiatry and Behavioral Health, Nationwide Children's Hospital, College of Medicine, and the Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Mallory Walters
- Department of Psychiatry and Behavioral Sciences, University of Texas Medical Branch, Galveston, USA
| | - Adannaya Ihediwa
- Department of Psychiatry and Behavioral Sciences, University of Texas Medical Branch, Galveston, USA
| | - Michel Adeniran
- Department of Psychiatry and Behavioral Sciences, University of Texas Medical Branch, Galveston, USA
| | - Lynnel Goodman
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Taryn L Mayes
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Kennard BD, Hughes JL, Minhajuddin A, Slater H, Blader JC, Mayes TL, Kirk C, Wakefield SM, Trivedi MH. Suicidal thoughts and behaviors in youth seeking mental health treatment in Texas: Youth Depression and Suicide Network research registry. Suicide Life Threat Behav 2023; 53:748-763. [PMID: 37530468 DOI: 10.1111/sltb.12980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 06/02/2023] [Accepted: 07/18/2023] [Indexed: 08/03/2023]
Abstract
INTRODUCTION Suicidality in youth is a serious public health problem. The Texas Youth Depression and Suicide Research Network (TX-YDSRN) was initiated in 2020 to create a research registry for youth with depression and/or suicidality in Texas. This report presents baseline clinical/demographic characteristics of the first 1000 participants, focusing on suicidal thoughts and behaviors. METHODS The registry includes 8-20-year-old youth receiving treatment for depression, or who screen positive for depression and/or suicidal ideation/behavior. Baseline data include diagnosis, depression/anxiety severity, suicidal ideation/behavior, trauma history, and measures of resilience. RESULTS We present baseline data on the first 1000 participants. Most (79.6%) of the sample had a primary depressive disorder. The sample had moderate to severe depression (Patient Health Questionnaire for Adolescents, PHQ-A; 12.9 ± 6.4) and anxiety (Generalized Anxiety Disorder, GAD-7; 11.3 ± 5.9). Nearly half reported ≥1 lifetime suicide attempts and 90% reported lifetime or current suicidal ideation. Participants with past/current suicidality (attempts and/or ideation) had greater illness severity (depression, anxiety, and suicidal thoughts/behaviors), lower resilience, and higher rates of trauma exposure than those without suicidality. CONCLUSIONS Baseline data indicate moderate levels of depression, anxiety, and suicidality and their correlates in this cohort. Future reports will determine trajectories of outcomes and predictors, moderators, and social determinants related to these outcomes.
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Affiliation(s)
- Beth D Kennard
- The Peter O'Donnell Jr. Brain Institute and the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Jennifer L Hughes
- Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio, USA
| | - Abu Minhajuddin
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Holli Slater
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Joseph C Blader
- University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Taryn L Mayes
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Claire Kirk
- Department of Psychiatry and Behavioral Sciences, University of Texas Medical Branch, Galveston, Texas, USA
| | - Sarah M Wakefield
- The Department of Psychiatry, Texas Tech University Health Science Center, Lubbock, Texas, USA
| | - Madhukar H Trivedi
- Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute and the Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Jha MK, Minhajuddin A, Slater H, Mayes TL, Blader J, Brown R, Garza C, Kennard BD, Riddle D, Storch EA, Shotwell J, Soutullo CA, Wakefield SM, Trivedi MH. Psychometric properties of Concise Associated Symptom Tracking (CAST) scale in youths and young adults: Findings from the Texas youth depression and suicide research network (TX-YDSRN). J Psychiatr Res 2023; 161:179-187. [PMID: 36933444 DOI: 10.1016/j.jpsychires.2023.03.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 03/06/2023] [Accepted: 03/08/2023] [Indexed: 03/20/2023]
Abstract
Symptoms of irritability, anxiety, panic, and insomnia are common in patients with depression, and their worsening after antidepressant treatment initiation is associated with poorer long-term outcomes. The Concise Associated Symptom Tracking (CAST) scale was developed to measure these symptoms in adults with major depressive disorder (MDD). Here, we evaluate the psychometric properties of CAST in an ongoing community-based observational study involving children, adolescents, and young adults. Individuals from the ongoing Texas Youth Depression and Suicide Research Network (TX-YDSRN; N = 952) with CAST data available were included. Fit statistics [Goodness of Fit Index (GFI), Comparative Fit Index (CFI), and Root Mean Square Error of Approximation (RMSEA)] from confirmatory factor analyses were used to evaluate the five- and four-domain structure of CAST. Item response theory (IRT) analyses were also used. Individuals were grouped based on age (in years) as youths (8-17) and young adults (18-20). Correlations with other clinical measures were used to inform construct validity. Four-domain (irritability, anxiety, panic, and insomnia) 12-item structure of CAST (CAST-12) was optimal for youths (N = 709, GFI = 0.906, CFI = 0.919, RMSEA = 0.095) and young adults (N = 243, GFI = 0.921, CFI = 0.938, RMSEA = 0.0797) with Cronbach's alpha of 0.87 and 0.88, respectively. Slope of each item exceeded 1.0 on IRT analyses suggesting adequate discrimination for each item. Scores on irritability, anxiety, panic, and insomnia were significantly correlated with similar items on other scales. Together these findings suggest that CAST-12 is a valid self-report measure of irritability, anxiety, insomnia, and panic in youths and young adults.
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Affiliation(s)
- Manish K Jha
- Department of Psychiatry, University of Texas Southwestern Medical Center in Dallas, TX, USA; Peter O'Donnell Jr. Brain Institute, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Abu Minhajuddin
- Department of Psychiatry, University of Texas Southwestern Medical Center in Dallas, TX, USA; Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Holli Slater
- Department of Psychiatry, University of Texas Southwestern Medical Center in Dallas, TX, USA
| | - Taryn L Mayes
- Department of Psychiatry, University of Texas Southwestern Medical Center in Dallas, TX, USA
| | - Joseph Blader
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Ryan Brown
- University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Cynthia Garza
- Department of Psychiatry, University of Texas Rio Grande Valley, School of Medicine, Edinburg, TX, USA
| | - Beth D Kennard
- Peter O'Donnell Jr. Brain Institute, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - David Riddle
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Eric A Storch
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | | | | | - Sarah M Wakefield
- Department of Psychiatry, Texas Tech University Health Science Center, Lubbock, TX, USA
| | - Madhukar H Trivedi
- Department of Psychiatry, University of Texas Southwestern Medical Center in Dallas, TX, USA; Peter O'Donnell Jr. Brain Institute, University of Texas Southwestern Medical Center, Dallas, TX, USA.
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Nandy K, Rush AJ, Carmody TJ, Mayes TL, Trivedi MH. The 9-item Concise Health Risk Tracking - Self-Report (CHRT-SR 9) measure of suicidal risk: Performance in adult primary care patients. Front Psychiatry 2023; 14:1014766. [PMID: 36865066 PMCID: PMC9971953 DOI: 10.3389/fpsyt.2023.1014766] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 01/23/2023] [Indexed: 02/16/2023] Open
Abstract
PURPOSE To evaluate the psychometric properties of a 9-item Concise Health Risk Tracking Self-Report (or CHRT-SR9) to assess suicidal risk in adult primary care outpatients. METHODS Overall, 369 adults completed the original 14-item version of CHRT-SR at baseline and within 4 months thereafter, from which the CHRT-SR9 was extracted using multigroup confirmatory factor analysis. Measurement invariance (across age and sex) and classical test theory characteristics of the CHRT-SR9 were evaluated. Concurrent validity was assessed by comparing CHRT-SR9 responses to those of the suicide item in the Patient Health Questionnaire (PHQ-9), both cross-sectionally and as a change measure over time. RESULTS Confirmatory factor analysis identified the CHRT-SR9 as the optimal solution. Factors included pessimism, helplessness, despair (2 items each) and suicidal thoughts (3 items). Measurement invariance held across sex and age groups, indicating that mean differences among sub-groups were real and not attributable to measurement bias. Classical test theory revealed acceptable item-total correlations overall (0.57-0.79) and internal consistency (Spearman-Brown from 0.76 to 0.90). Concurrent validity analyses revealed that the CHRT-SR9 can measure both improvement and worsening of suicidality over time. A PHQ-9 response of 0, 1, 2, and 3 on the suicide item corresponded to 7.82 (5.53), 16.80 (4.99), 20.71 (5.36), and 25.95 (7.30) (mean and SD) on CHRT-SR9 total score, respectively. CONCLUSION The CHRT-SR9 is a brief self-report evaluating suicidality with excellent psychometric properties that is sensitive to change over time.
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Affiliation(s)
- Karabi Nandy
- Peter O'Donnell School of Public Health, The University of Texas Southwestern Medical Center, Dallas, TX, United States.,Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - A John Rush
- Curbstone Consultant LLC., Santa Fe, NM, United States.,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States.,Department of Psychiatry, Duke-National University of Singapore, Singapore, Singapore
| | - Thomas J Carmody
- Peter O'Donnell School of Public Health, The University of Texas Southwestern Medical Center, Dallas, TX, United States.,Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Taryn L Mayes
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Madhukar H Trivedi
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, United States
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