Innovations In Clinical Neuroscience

SEP-OCT 2014

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

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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 ] 42 phenomena to categories 2, 3, and 4 in the C–SSRS. Less severe but still significant disagreement is seen on "intermediate levels" of suicide attempts (i.e., between preparatory acts and actual attempt). As with the ideation categories, there is general agreement among all scales when the C–SSRS categorizes patients as not falling into categories 8 and 9 (interrupted and aborted suicide attempt, respectively). However, when the C–SSRS rates patients as meeting criteria for these categories, the ISST-Plus and the S-STS are more likely to agree with each other but to disagree with the C–SSRS. It was our impression that delineation of each of these three categories from each other is not precise enough in the C–SSRS and the FDA-CASA 2012 and leaves too much latitude for raters and patients to vary in their interpretations and abilities to respond to questions about these phenomena. The differences may be a function of ambiguity in the C–SSRS navigation instructions and mismatches between probe q uestions, the title names, and the category definitions for the C–SSRS suicidal ideation categories. They may also be a function of rater and patient difficulty in reliably rating the complex combinations on these four active suicidal ideation categories as they appear on the C– SSRS. Differences in categorization observed for the three scales may be related to differences in the instruments' approaches to collecting SIB data, problems in FDA-CASA 2012 classification, variability in patient reports, and rater reliability. The findings suggest a need to conduct larger-scale psychometric studies, including inter-rater and intra-rater reliability testing at additional sites. These studies should include a diverse sample of psychiatric and medical co-morbidities and subjects with diverse ethnic and religious backgrounds. Limitations. The study had several limitations: 1) the sample size of the study was modest; 2) the Kappa values might have been affected by low base rates; 3) the results for FDA-CASA 2012 categories 6, 12, 13, and 14 could not be analyzed since these items did not occur in the subjects surveyed; and 4) emphasis in the C–SSRS on suicidal patients meant that it could not be used as a standard reference for category 15 (other, [no deliberate self-harm]). CONCLUSION Concordance of the ISST-Plus and S-STS to the C–SSRS was acceptable for categories 1, 5, 6, 10, and 11, but not for the active suicidal ideation categories 2, 3, 4, or for the aborted and interrupted suicide attempt categories 8 and 9. Based on the results of this exploratory study, we cannot recommend merging data collected using these scales into a common database for meta-analyses. Indeed FIGURE 6. Negative Predictive Value (NPV) for each scale by FDA-CASA 2012 classification 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 FIGURE 7. Positive Predictive Value (PPV) for each scale by FDA-CASA 2012 classification 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

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