Innovations In Clinical Neuroscience

SEP-OCT 2014

A peer-reviewed, evidence-based journal for clinicians in the field of neuroscience

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[ V O L U M E 1 1 , N U M B E R 9 – 1 0 , S E P T E M B E R – O C T O B E R 2 0 1 4 ] Innovations in CLINICAL NEUROSCIENCE 37 Kappa values were acceptable to high for categories 1, 5, 7, 10, and 11 but low for the other categories. Sensitivity was high (≥0.80) for " Passive ideation" (#1), "Suicide attempt" (#7), and "Preparatory acts" (#10). Sensitivity was acceptable (0.40–0.79) for "Active suicidal ideation: method, intent, and plan" (#5) and "Self-Injurious Behavior Without Suicidal Intent" (#11). Sensitivity was low for the remaining categories of active suicidal ideation (#2, #3, and #4) as well as for interrupted and aborted attempt categories (#8 and #9). In contrast, specificity was high (>0.80) for every category on the ISST-Plus. NPV was high for all of the categories with the exception of the active ideation categories 2, 3, and 4. PPV values were high for categories 1, 3, 5, and 7 and acceptable for categories 10 and 11, but low for categories 4, 8, and 9. Agreement between the S-STS and C–SSRS. AUC values were good to excellent (0.80–1.00) for all three versions of the S-STS for "Passive ideation" (#1), "Active suicidal ideation: method, intent, and plan" (#5), "Suicidal attempt" (#7), and "Self-Injurious Behavior Without Suicidal Intent" (#11). The AUC was acceptable (0.70–0.80) for "Preparatory acts" (#10) on the clinician version of the S-STS but not on the patient version or reconciled version. AUC values were poor (<0.70) for categories "Active suicidal ideation: nonspecific" (#2), "Active suicidal ideation: method, but no intent or plan" (#3), "Active suicidal ideation: method and intent, but no plan" (#4), "Interrupted suicide attempt" (#8) and "Aborted suicide attempt" (#9). Kappa values were acceptable to excellent for all of the categories on all three S-STS versions with the following exceptions: kappa values were low for the active suicidal ideation categories 2, 3, and 4 and for "Aborted attempt" (#9) on all three S-STS versions. Kappa was also low for "Interrupted attempt" (#8) and "Preparatory behavior" (#10) on the clinician version. Sensitivity was high (≥0.80) for "Passive ideation" (#1), "Active suicidal ideation: method, intent, and plan" (#5), and "Self-Injurious Behavior Without Suicidal Intent" (#11) on all three versions. It was also high for "Suicide attempt" (#7) on the patient and reconciled versions. Sensitivity was acceptable (0.60 on the patient version and 0.40 on the clinician version) for "Preparatory acts" (#10). Sensitivity was low for the remaining categories of active suicidal ideation (#2, #3, and #4) as well as for the interrupted and aborted attempt categories (#8 and #9) on all three versions. Specificity, on the other hand, was high (>0.80) for the active ideation categories (#2, #3, and #4), for the clinician version of "Active ideation" (#5), as well as for the interrupted and aborted attempt categories (#8 and #9) and for "Suicide attempt" (#7). It was acceptable but somewhat lower (0.70-0.80) for "Passive ideation" (#1) on all three versions. This result is undoubtedly a function of the S-STS detecting more passive ideation than the C–SSRS, since it asks about different subtypes of passive suicidal ideation than does the C–SSRS. 23 Taken together, these results indicate that the S-STS and the C–SSRS were in general agreement as far as ruling out most of the categories of active ideation, but not on ruling in categories 2, 3, and 4. NPVs were acceptable to high for all of the categories with the exception of the two active ideation categories: "Active suicidal ideation: nonspecific" (#2) and "Active suicidal ideation: method, but no intent or plan" (#3). PPVs were high on patient-rated version for categories 1, 4, 7, 8, and 9, on the clinician and reconciled versions for categories 1, 3, 7, and 11, but low for categories 2 and 3. The patient-rated S-STS was quite discrepant from the C–SSRS in mapping categories 2, 3, and 4 and to a lesser extent in mapping categories 8 and 9. The S-STS reconciled scale TABLE 2. Definitions of tests of agreement Standard Reference (C–SSRS) Present Absent Test Instrument Present A B Absent C D Sensitivity: When present according to the C–SSRS (standard reference scale), how often does the test instrument detect the condition? A/(A + C) Specificity: When absent according to the C–SSRS (standard reference scale), how often does the test instrument say the condition is absent? D/(D + B) Positive Predictive Value (PPV): When present according to the test instrument, how often does the C–SSRS (standard reference scale) agree? A/(A + B) Negative Predictive Value (NPV): When absent according to the test instrument, how often does the C–SSRS (standard reference scale) agree? D/(C + D) Area Under the Receiver Operating Characteristic Curve (AUC): What is the probability that a randomly selected patient with the trait is more likely to be categorized as having the trait relative to a randomly selected subject without the trait? When both the predictor and the criterion variables are binary, this is calculated by (Sensitivity + Specificity)/2. ROC curve analysis is used to evaluate the precision of the best-fitting prediction equations of each scale relative to the C–SSRS and may be the best overview assessment of the data (see references 21 and 22). C–SSRS: Columbia–Suicide Severity Rating Scale

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