Psychometric validation of the Columbia-Suicide Severity rating scale in Spanish-speaking adolescents
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Introduction:
Adolescent suicide is a major public health issue, and early and accurate detection is of great concern. There are many reliable instruments for this purpose, such as the Columbia-Suicide severity rating scale (C-SSRS), but no validation exists for Spanish speaking Latin American adolescents.
Objetive:
To assess psychometric properties and cut-off scores of the C-SSRS in Spanish speaking adolescents.
Methods:
Exploratory assessment with principal component analysis (PCA) and Varimax rotation, and confirmatory analysis (CFA) were performed on two groups with 782 and 834 participants respectively (N=1616). Mean age was 24.8 years. A Receiver operator analysis was applied to distinguish between control and suicide-risk subgroups adolescents.
Results:
Promax rotation yielded two 10-items factors, for suicide ideation and behavior respectively. C-SSRS was positively correlated with other suicide risk scales, such as Beck Depression Inventory-II, Suicidal Behaviors Questionnaire-Revised, or PHQ-9. Confirmatory factor analysis yielded a two-factor solution as the best goodness of fit model. C-SSRS showed adequate ability to detect suicide risk group with positive predictive value of 68.3%. ROC analyses showed cutoff scores of ≥ 6 and ≥ 4 for suicide ideation and behavior scales respectively
Conclusion:
This research offers data supporting psychometric validity and reliability of C-SSRS in nonclinical Spanish-speaking students. Added benefits are flexible scoring and management easiness. This questionnaire yields data on distinct aspects of suicidality, being more parsimonious than separate administration of a bunch of questionnaires.
- Columbia-Suicide Severity Rating Scale
- adolescents
- psychometric validation
- cut-off scores Go to
World Health Organization Preventing suicide A resource for primary health care workers. Geneva: World Health Organization. 2000:5–6.
Värnik P. Suicide in the world. Int J Environ Res Public Health. 2012;9:760–771. DOI: https://doi.org/10.3390/ijerph9030760
Laanani M, Ghosn W, Jougla E, Rey G. Impact of unemployent variations on suicide mortality in Western European countries (2000-2010) J Epidemiol Community Health. 2015;69(2):103–109. DOI: https://doi.org/10.1136/jech-2013-203624
Wasserman D, Cheng Q, Jiang G-X. Global suicide rates among young people aged 15-19. World Psychiatry. 2005;4(2):114–120.
Phillips MR. Rethinking the role of mental illness in suicide. Am J Psychiatry. 2010. 167(7): 731-3.Phillips MR. Rethinking the role of mental illness in suicide. Am J Psychiatry. 2010;167(7):731–733. DOI: https://doi.org/10.1176/appi.ajp.2010.10040589
Kõlves K, Milner A, Värnik P. Suicide rates and socioeconomic factors in Eastern European countries after the collapse of the Soviet Union trends between 1990 and 2008. Sociol Health Illn. 2013;35(6):956–970. DOI: https://doi.org/10.1111/1467-9566.12011
Kwon JW, Chun H, Cho S. A closer look at the increase in suicide rates in South Korea from 1986-2005. BMC Public Health. 2009;9:72–72. DOI: https://doi.org/10.1186/1471-2458-9-72
Law S, Liu P. Suicide in China Unique demographic patterns and relationship to depressive disorder. Curr Psychiatry Rep. 2008;10:80–86. DOI: https://doi.org/10.1007/s11920-008-0014-5
Vijayakumar L. Indian research on suicide. Indian J Psychiatry. 2010;52:S291–S296. doi: 10.4103/0019-5545.69255. DOI: https://doi.org/10.4103/0019-5545.69255
Pearson M, Zwi AB, Buckley NA. Research prospective policy analysis How an epistemic community informed policymaking on intentional self-poisoning in Sri Lanka. Health Res Policy Syst. 2010;8:19–19. DOI: https://doi.org/10.1186/1478-4505-8-19
Corona B, Hernández M, Lomba P. Epidemiology of suicide in Cuba, 1987-2014. MEDICC Rev. 2016;18(3):15–20. DOI: https://doi.org/10.37757/MR2016.V18.N3.4
Vignolo J, Henderson E, Vacarezza M, Alvarez C, Alegretti M, Sosa A. Análisis de 123 años de muertes por suicidio en el Uruguay, 1887-2010. Rev Sal Pública. 2013;17(1):8–18.
González F, López R, Gascón S, Campayo JG. Epidemiological issues regarding suicides in Ecuador an 8-year report. J Publ Health. 2011;19(2):161–169. DOI: https://doi.org/10.1007/s10389-010-0372-4
Jørs E, Christoffersen M, Veirum NH, Aquilar GC, Morant RC, Konradsen F. Suicide attempts and suicides in Bolivia from 2007 to 2012: pesticides are the preferred method - females try but males commit suicide. Int J Adolesc Med Health. 2014;26(3):361–367. DOI: https://doi.org/10.1515/ijamh-2013-0309
Palhares-Alves HN, Palhares DM, Laranjeira R, Nogueira-Martins LA, Sanchez ZM. Suicide among physicians in the state of São Paulo, Brazil, across one decade. Rev Bras Psiquiatr. 2015;37(2):146–149. DOI: https://doi.org/10.1590/1516-4446-2014-1534
Teti GL, Rebok F, Grendas LN, Rodante D, Fógola A, Daray FM. Patients hospitalized for suicidal ideation and suicide attempt in a Mental Health Hospital Clinico-demographical features and 6-month follow-up. Vertex. 2014;25(115):203–212.
Sánchez R, Orejarena S, Guzmán Y. Characteristics of suicides in Bogotá, 1985-2000. Rev Salud Pública. 2004;6(3):217–234. DOI: https://doi.org/10.1590/S0124-00642004000300001
Anestis MD, Soberay KA, Gutierrez PM, Hernández TD, Joiner TE. Reconsidering the link between impulsivity and suicidal behavior. Pers Soc Psychol Rev. 2014;18(4):366–386. DOI: https://doi.org/10.1177/1088868314535988
Sarchiapone M, Mandelli L, Iosue M, Andrisano C, Roy A. Controlling access to suicide means. Int J Environ Res Public Health. 2011;8(12):4550–4562. DOI: https://doi.org/10.3390/ijerph8124550
Kann L, Kinchen S, Shanklin SL, Flint KH, Kawkins J, Harris WA, et al. Youth risk behavior surveillance-United States, 2013. MMWR Suppl. 2014;63(Suppl 4):1–168.
Nock MK, Green JG, Hwang I, McLaughlin KA, Sampson NA, Zaslavsky AM. Prevalence, correlates and treatment of lifetime suicidal behavior among adolescents Results from the National Comorbidity Survey Replication - Adolescent Supplement (NCS-A) JAMA Psychiatry. 2013;70(3):300–310. DOI: https://doi.org/10.1001/2013.jamapsychiatry.55
Quinlan-Davidson M, Sanhueza A, Espinosa I, Escamilla-Cejudo JA, Maddaleno M. Suicide among young people in the Americas. J Adolesc Health. 2014;54(3):262–268. DOI: https://doi.org/10.1016/j.jadohealth.2013.07.012
Kairi K, De Leo D. Regions with the highest suicide rates for children and adolescents-some observations. J Child Adolesc Behav. 2014;2(2):e104
Saunders K, Brand F, Lascelles K, Hawton K. The sad truth about the SADPERSONS Scale an evaluation of its clinical utility in self-harm patients. Emerg Med J. 2014;31(10):796–798. DOI: https://doi.org/10.1136/emermed-2013-202781
Posner K, Brown GK, Stanley B, Brent DA, Yershova KV, Oquendo MA, Mann J. The Columbia-Suicide Severity Rating Scale initial validity and internal consistency findings from three multisite studies with adolescents and adults. Am J Psychiatry. 2011;168(12):1266–1277. DOI: https://doi.org/10.1176/appi.ajp.2011.10111704
Miranda R, Scott M, Hicks R, Wilcox HC, Munfakh JL, Shaffer D. Suicide attempt characteristics, diagnoses, and future attempts comparing multiple attempters to single attempters and ideators. J Am Acad Child Adolesc Psychiatry. 2008;47(1):32–40. DOI: https://doi.org/10.1097/chi.0b013e31815a56cb
Posner K, Oquendo MA, Gould M, Stanley B, Davies M. Columbia Classification Algorithm of Suicide Assessment (C-CASA) classification of suicidal events in the FDA’s pediatric suicidal risk analysis of antidepressants. Am J Psychiatry. 2007;164(7):1035–1043. DOI: https://doi.org/10.1176/ajp.2007.164.7.1035
Viguera AC, Milano N, Laurel R, Thompson NR, Griffith SD, Baldessarini RJ, Katzan IL. Comparison of electronic screening for suicidal risk with the patient health questionnaire item 9 and the Columbia suicide severity rating scale in an outpatient psychiatric clinic. Psychosomatics. 2015;56(5):460–469. DOI: https://doi.org/10.1016/j.psym.2015.04.005
Giddens JM, Sheehan KH, Sheehan DV. The Columbia-Suicide Severity Rating Scale (C-SSRS) Has the “gold standard” become a liability? Innov Clin Neurosci. 2014;11(9-10):66–66.
Sheehan DV, Alphs LD, Mao L, Li Q, May RS, Bruer EH. Comparative validation of the S-STS, the ISST-Plus, and the C-SSRS for assessing the suicidal thinking and behavior FDA 2012 suicidality categories. Innov Clin Neurosci. 2014;11(9-10):32–46.
Alonso J, Prieto L, Anto JM. La versión española del SF-36 Health Survey (Cuestionario de Salud SF-36) un instrumento para la medida de los resultados clínicos. Med Clin (Barc) 1995;104:771–776.
Martínez Z, Páramo MF, Guisande MA, Tinajero C, da Silva L, Rodríguez M. Apoyo social en universitarios españoles de primer año propiedades psicométricas del Social Support Questionnaire-Short Form y el Social Provisions Scale. Rev Latinoam Psicol. 2014;46(2):102–110. DOI: https://doi.org/10.1016/S0120-0534(14)70013-5
Rubio G, Bermejo J, Caballero MC, Santo-Domingo J. Validación de la prueba para la identificación de trastornos por uso de alcohol (AUDIT) en atención primaria. Rev Clin Esp. 1998;198:11–14.
Sanz J, Perdigón AL, Vázquez C. Adaptación española del Inventario para la Depresión de Beck-II (BDI-II) 2. Propiedades psicométricas en población general. Clínica y Salud. 2003;14:249–280.
Osman A, Bagge CL, Gutierrez PM, Konick LC, Kopper BA, Barrios FX. The Suicidal Behaviors Questionnaire-Revised (SBQ-R) validation with clinical and nonclinical samples. Assessment. 2001;8:443–443. DOI: https://doi.org/10.1177/107319110100800409
Hewitt PL, Caelian CF, Chen C, Flett GL. Perfectionism, stress, daily hassles, hopelessness, and suicide potential in depressed psychiatric adolescents. J Psychopathol Behav Assess. 2014;36:663–674. DOI: https://doi.org/10.1007/s10862-014-9427-0
Aliaga TJ, Rodríguez RL, Ponce DC, Frisancho LA, Enríquez VJ. Escala de desesperanza de Beck (BHS) Adaptación y características psicométricas. Rev Invest Psicol. 2006;9(1):69–79. DOI: https://doi.org/10.15381/rinvp.v9i1.4029
Cabañero MJ, Richard M, Cabrero J, Orts I, Reig A, Tosal B. Fiabilidad y validez de la escala de satisfacción con la vida de Diener en una muestra de mujeres embarazadas y puérperas. Psicothema. 2004;16:448–455.
Villalobos F. Validez y fiabilidad del Inventario de Ideación Suicida Positiva y Negativa-PANSI, en estudiantes colombianos. Universitas Psychologica. 2010;9(2):509–520. DOI: https://doi.org/10.11144/Javeriana.upsy9-2.vfii
Baader MT, Molina FJ, Venezian B, Rojas C, Farías S, Fierro C. Validación y utilidad de la encuesta PHQ-9 (Patient Health Questionnaire) en el diagnóstico de depresión en pacientes usuarios de atención primaria en Chile. Rev Chil Neuro-Psiquiat. 2012;50(1):10–22. DOI: https://doi.org/10.4067/S0717-92272012000100002
Ulloa RE, Ortiz S, Higuera F, Nogales I, Fresán A, Apiquian R. Estudio de fiabilidad interevaluador de la versión en español de la entrevista Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime version (K-SADS-PL) Actas Esp Psiquiatr. 2006;34:36–40.
Osman A, Bagge CL, Gutierrez PM, Konick LC, Kopper BA, Barrios FX. The Suicidal Behaviors Questionnaire-Revised (SBQ-R) Validation with clinical and nonclinical samples. Assessment. 2001;8:443–454. DOI: https://doi.org/10.1177/107319110100800409
Storch EA, Roberti JW, Roth DA. Factor structure, concurrent validity, and internal consistency of the Beck Depression Inventory-Second Edition in a sample of college students. Depress Anxiety. 2004;19(3):187–189. DOI: https://doi.org/10.1002/da.20002
Birmaher B, Ehmann M, Axelson DA, Goldstein BI, Monk RNK, Kalas RNC. Schedule for affective disorders and schizophrenia for school-age children (K-SADS-PL) for the assessment of preschool children- a preliminary psychometric study. J Psychiat Res. 2009;43(7):680–686. DOI: https://doi.org/10.1016/j.jpsychires.2008.10.003
Manea L, Gilbody S, McMillan D. Optimal cut-off score for diagnosing depression with the Patient Health Questionnaire (PHQ-9) a meta-analysis. Can Med Assoc J. 2012;184(3):E191–E196. DOI: https://doi.org/10.1503/cmaj.110829
Bentler PM, Wu E. EQS structural equations program. Encino, CA: Multivariate Software; 2001. Version 6.0.
Bollen KA. A new incremental fit index for general structural equation models. Sociol Methods Res. 1889;17:303–316. DOI: https://doi.org/10.1177/0049124189017003004
Browne MW, Cudeck R. Alternative ways of assessing model fit. Sociol Methods Res. 1992;21:230–258. DOI: https://doi.org/10.1177/0049124192021002005
Joiner TE, Steer RA, Brown G, Beck AT, Pettit JW, Rudd MD. Worst-point suicidal plans a dimension of suicidality predictive of past suicide attempts and eventual death by suicide. Behav Res Ther. 2003;41:1469–1480.. DOI: https://doi.org/10.1016/S0005-7967(03)00070-6
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