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Short term risk of non-fatal and fatal suicidal behaviours: the predictive validity of the Columbia-Suicide Severity Rating Scale in a Swedish adult psychiatric population with a recent episode of self-harm.
BMC Psychiatry. 2018 10 01; 18(1):319.BP

Abstract

BACKGROUND

The Columbia-Suicide Severity Rating Scale (C-SSRS) is a relatively new instrument for the assessment of suicidal ideation and behaviour that is widely used in clinical and research settings. The predictive properties of the C-SSRS have mainly been evaluated in young US populations. We wanted to examine the instrument's predictive validity in a Swedish cohort of adults seeking psychiatric emergency services after an episode of self-harm.

METHODS

Prospective cohort study of patients (n = 804) presenting for psychiatric emergency assessment after an episode of self-harm with or without suicidal intent. Suicidal ideation and behaviours at baseline were rated with the C-SSRS and subsequent non-fatal and fatal suicide attempts within 6 months were identified by record review. Logistic regression was used to evaluate separate ideation items and total scores as predictors of non-fatal and fatal suicide attempts. Receiver operating characteristics (ROC) curves were constructed for the suicidal ideation (SI) intensity score and the C-SSRS total score.

RESULTS

In this cohort, the median age at baseline was 33 years, 67% were women and 68% had made at least one suicide attempt prior to the index attempt. At least one non-fatal or fatal suicide attempt was recorded during follow-up for 165 persons (20.5%). The single C-SSRS items frequency, duration and deterrents were associated with this composite outcome; controllability and reasons were not. In a logistic regression model adjusted for previous history of suicide attempt, SI intensity score was a significant predictor of a non-fatal or fatal suicide attempt (OR 1.08; 95% CI 1.03-1.12). ROC analysis showed that the SI intensity score was somewhat better than chance in correctly classifying the outcome (AUC 0.62, 95% CI 0.57-0.66). The corresponding figures for the C-SSRS total score were 0.65, 95% CI 0.60-0.69.

CONCLUSIONS

The C-SSRS items frequency, duration and deterrents were associated with elevated short term risk in this adult psychiatric cohort, as were both the SI intensity score and the C-SSRS total score. However, the ability to correctly predict future suicidal behaviour was limited for both scores.

Authors+Show Affiliations

Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, S:t Görans Hospital, Vårdvägen 1, SE-112 81, Stockholm, Sweden. asa.lindh@ki.se.Department of Psychiatry and Neurochemistry, University of Göteborg, Gothenburg, Sweden.Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, S:t Görans Hospital, Vårdvägen 1, SE-112 81, Stockholm, Sweden.Department of Clinical Sciences, Division of Psychiatry, University of Umeå, Umeå, Sweden.Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, S:t Görans Hospital, Vårdvägen 1, SE-112 81, Stockholm, Sweden.Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, S:t Görans Hospital, Vårdvägen 1, SE-112 81, Stockholm, Sweden.

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

30285661

Citation

Lindh, Åsa U., et al. "Short Term Risk of Non-fatal and Fatal Suicidal Behaviours: the Predictive Validity of the Columbia-Suicide Severity Rating Scale in a Swedish Adult Psychiatric Population With a Recent Episode of Self-harm." BMC Psychiatry, vol. 18, no. 1, 2018, p. 319.
Lindh ÅU, Waern M, Beckman K, et al. Short term risk of non-fatal and fatal suicidal behaviours: the predictive validity of the Columbia-Suicide Severity Rating Scale in a Swedish adult psychiatric population with a recent episode of self-harm. BMC Psychiatry. 2018;18(1):319.
Lindh, Å. U., Waern, M., Beckman, K., Renberg, E. S., Dahlin, M., & Runeson, B. (2018). Short term risk of non-fatal and fatal suicidal behaviours: the predictive validity of the Columbia-Suicide Severity Rating Scale in a Swedish adult psychiatric population with a recent episode of self-harm. BMC Psychiatry, 18(1), 319. https://doi.org/10.1186/s12888-018-1883-8
Lindh ÅU, et al. Short Term Risk of Non-fatal and Fatal Suicidal Behaviours: the Predictive Validity of the Columbia-Suicide Severity Rating Scale in a Swedish Adult Psychiatric Population With a Recent Episode of Self-harm. BMC Psychiatry. 2018 10 1;18(1):319. PubMed PMID: 30285661.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Short term risk of non-fatal and fatal suicidal behaviours: the predictive validity of the Columbia-Suicide Severity Rating Scale in a Swedish adult psychiatric population with a recent episode of self-harm. AU - Lindh,Åsa U, AU - Waern,Margda, AU - Beckman,Karin, AU - Renberg,Ellinor Salander, AU - Dahlin,Marie, AU - Runeson,Bo, Y1 - 2018/10/01/ PY - 2018/05/04/received PY - 2018/09/12/accepted PY - 2018/10/5/entrez PY - 2018/10/5/pubmed PY - 2019/9/17/medline KW - Classification KW - Outcome KW - Risk factors KW - Self-harm KW - Suicide SP - 319 EP - 319 JF - BMC psychiatry JO - BMC Psychiatry VL - 18 IS - 1 N2 - BACKGROUND: The Columbia-Suicide Severity Rating Scale (C-SSRS) is a relatively new instrument for the assessment of suicidal ideation and behaviour that is widely used in clinical and research settings. The predictive properties of the C-SSRS have mainly been evaluated in young US populations. We wanted to examine the instrument's predictive validity in a Swedish cohort of adults seeking psychiatric emergency services after an episode of self-harm. METHODS: Prospective cohort study of patients (n = 804) presenting for psychiatric emergency assessment after an episode of self-harm with or without suicidal intent. Suicidal ideation and behaviours at baseline were rated with the C-SSRS and subsequent non-fatal and fatal suicide attempts within 6 months were identified by record review. Logistic regression was used to evaluate separate ideation items and total scores as predictors of non-fatal and fatal suicide attempts. Receiver operating characteristics (ROC) curves were constructed for the suicidal ideation (SI) intensity score and the C-SSRS total score. RESULTS: In this cohort, the median age at baseline was 33 years, 67% were women and 68% had made at least one suicide attempt prior to the index attempt. At least one non-fatal or fatal suicide attempt was recorded during follow-up for 165 persons (20.5%). The single C-SSRS items frequency, duration and deterrents were associated with this composite outcome; controllability and reasons were not. In a logistic regression model adjusted for previous history of suicide attempt, SI intensity score was a significant predictor of a non-fatal or fatal suicide attempt (OR 1.08; 95% CI 1.03-1.12). ROC analysis showed that the SI intensity score was somewhat better than chance in correctly classifying the outcome (AUC 0.62, 95% CI 0.57-0.66). The corresponding figures for the C-SSRS total score were 0.65, 95% CI 0.60-0.69. CONCLUSIONS: The C-SSRS items frequency, duration and deterrents were associated with elevated short term risk in this adult psychiatric cohort, as were both the SI intensity score and the C-SSRS total score. However, the ability to correctly predict future suicidal behaviour was limited for both scores. SN - 1471-244X UR - https://www.unboundmedicine.com/medline/citation/30285661/Short_term_risk_of_non_fatal_and_fatal_suicidal_behaviours:_the_predictive_validity_of_the_Columbia_Suicide_Severity_Rating_Scale_in_a_Swedish_adult_psychiatric_population_with_a_recent_episode_of_self_harm_ L2 - https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-018-1883-8 DB - PRIME DP - Unbound Medicine ER -