Innovations In Clinical Neuroscience

SEP-OCT 2014

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

Issue link: http://innovationscns.epubxp.com/i/425963

Contents of this Issue

Navigation

Page 39 of 201

Innovations in CLINICAL NEUROSCIENCE [ 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 ] 40 version done because their scores on the patient- and clinician-rated versions of the S-STS were identical. For 34 of the 37 participants (91.9%), there was at least one score difference between the patient- and clinician-rated versions of the S-STS. Consequently, the reconciliation version of S-STS was needed for these 34 subjects. The reconciliation between patient and clinician versions required less than three minutes, even in suicidal subjects. Overall, the results show that assessments of suicidality can be done in a short time frame using any of these scales and that the patient- rated version of the S-STS takes approximately the same length of time as the clinician versions. DISCUSSION This study is the first examination of the concurrent validity of the ISST-Plus and S-STS in relation to the C–SSRS. The study has several important strengths: 1) assessments were all made by different raters who were blind to the results of the other interviews (avoiding potential rater bias); 2) clinician interviews were randomly sequenced (mitigating against possible order effects); and 3) direct data capture and computer- coded mapping precluded missing values, double entries, legibility problems, and transcription errors for ISST-Plus and S-STS data. Overall, there was good agreement on all three scales for some categories and poor agreement for others. The greatest disagreement between the test instruments and the C–SSRS was seen in patients with "intermediate levels" of active suicidal ideation (categories 2, 3, and 4) (i.e., categories short of including all 3 of method, intent, and plan). Specifically the C–SSRS endorsed category 2 ("Non-specific active suicidal thoughts") 13 or more times as often as the ISST-Plus and S-STS with almost two-thirds (65%) of the 40 patients mapping to this category on the C–SSRS compared to five percent or less on the ISST-Plus and the three versions of the S-STS. Similar patterns were observed for the active ideation categories 3 and 4 T ABLE 4, continued. Percent agreement, n (%), kappa, and A UC for ISST-Plus vs. C-SSRS a nd S-STS vs. C-SSRS I SST-PLUS (N = 40) S -STS (PATIENT) (N = 40) S -STS (CLINICIAN) (N = 40) S -STS (RECONCILED) (N = 39) No Yes No Yes No Yes No Yes FDA-CASA 2012 Category 10: Preparatory acts toward imminent suicidal behavior C -SSRS No Y es 2 5 (62.5) 1 (2.5) 5 (12.5) 9 (22.5) 2 6 (65.0) 4 (10.0) 4 (10.0) 6 (15.0) 2 8 (70.0) 6 (15.0) 2 (5.0) 4 (10.0) 2 9 (74.4) 1 0 (25.6) 0 0 % Agreement* P value** K appa (95% CL) A UC 3 4/40 (85.0) 0.102 0 .647 (0.396, 0.898) 0 .867 3 2/40 (80.0) 1.000 0 .467 (0.151, 0.782) 0 .733 3 2/40 (80.0) 0.157 0 .385 (0.048, 0.722) 0 .667 2 9/39 (74.4) - - 0 .500 FDA-CASA 2012 Category 11: Self-injurious behavior without suicidal intent C -SSRS No Yes 2 7 (67.5) 5 (12.5) 2 (5.0) 6 (15.0) 2 2 (55.0) 1 (2.5) 7 (17.5) 10 (25.0) 2 9 (72.5) 3 (7.5) 0 8 (20.0) 2 9 (74.4) 1 (2.6) 0 9 (23.1) % Agreement* P value** Kappa (95% CL) AUC 3 3/40 (82.5) 0.257 0.521 (0.215, 0.826) 0.738 3 2/40 (80.0) 0.034 0.571 (0.320, 0.822) 0.834 3 7/40 (92.5) 0.083 0.795 (0.576, 1.000) 0.864 3 8/39 (97.4) 0.317 0.930 (0.796, 1.000) 0.950 * % Agreement: raw concordance ** P value based on McNemar's test of significance I SST-Plus: InterSePT Scale for Suicidal Thinking-Plus; S-STS (Patient): Sheehan-Suicidality Tracking Scale patient-rated version; S-STS (Clinician): Sheehan-Suicidality Tracking Scale clinician-rated version; C–SSRS: Columbia–Suicide Severity Rating Scale; AUC: Area under Receiver Operating Curve FIGURE 3. Area under curve (AUC) for the ISST-Plus and S-STS by FDA-CASA 2012 category relative to the C–SSRS ISST-Plus: InterSePT Scale for Suicidal Thinking-Plus; S-STS (Patient): Sheehan-Suicidality Tracking Scale patient-rated version; S-STS (Clinician): Sheehan-Suicidality Tracking Scale clinician-rated version; S-STS (Reconciled): Sheehan-Suicidality Tracking Scale reconciled version; C–SSRS: Columbia–Suicide Severity Rating Scale

Articles in this issue

Archives of this issue

view archives of Innovations In Clinical Neuroscience - SEP-OCT 2014