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 ] 66 ABSTRACT Objective: The Columbia– Suicide Severity Rating Scale has become the gold standard for the assessment of suicidal ideation and behavior in clinical trials. Criticism of the instrument has been mounting. We examine whether the instrument meets widely accepted psychometric standards and maps to the United States Food and Drug Administration's most recent 2012 algorithm for assessment of suicidal phenomena. Our goal is to determine if the Columbia–Suicide Severity Rating Scale should be retained as the preferred instrument for assessment of suicidal ideation and behavior. Method: Standard psychometric criteria dictate that categorizations to avoid type I and type II errors should be comprehensive and address the full spectrum (i.e., all dimensions) of a phenomenon. The criteria should also be well defined and consistent, and the wording throughout should be unambiguous. We examine the Columbia–Suicide Severity Rating Scale in terms of these criteria. Results: The Columbia–Suicide Severity Rating Scale does not address the full spectrum of suicidal ideation or behavior. As a result, it has the potential to miss many combinations of suicidal ideation and behavior that present to clinicians in practice (type II error). Potential misclassifications (type I and II errors) are compounded by flawed navigation instructions; mismatches in category titles, definitions, and probes; and wording that is susceptible to multiple interpretations. Further, the Columbia–Suicide Severity Rating Scale in its current form does not map to the 2012 Food and Drug Administration's draft classification FUNDING: There was no funding for the development and writing of this article. FINANCIAL DISCLOSURES: J. Giddens is the author and copyright holder of the Suicide Plan Tracking Scale (SPTS) and is a named consultant on the Sheehan-Suicidality Tracking Scale (S-STS), the Sheehan-Suicidality Tracking Scale Clinically Meaningful Change Measure Version (S-STS CMCM), the Pediatric versions of the S-STS, and the Suicidality Modifiers Scale; Dr. K. Sheehan is the spouse of Dr. D. Sheehan, who is the author and copyright holder of the S-STS, the S-STS CMCM, the Pediatric versions of the S-STS, the Sheehan Disability Scale (SDS), and the Suicidality Modifiers Scale, is a co-author of the SPTS, the Mini International Neuropsychiatric Interview (MINI), and owns stock in Medical Outcomes Systems, which has computerized the MINI and the S-STS. She has no other conflicts to report; and Dr. D. Sheehan is the author and copyright holder of the S-STS, the S-STS CMCM, the Pediatric versions of the S-STS, the SDS, and the Suicidality Modifiers Scale, is a co- author of the SPTS, the Mini International Neuropsychiatric Interview (MINI), and owns stock in Medical Outcomes Systems, which has computerized the MINI and the S-STS. ADDRESS CORRESPONDENCE TO: David V. Sheehan, MD, MBA; E-mail: dsheehan@health.usf.edu KEY WORDS: Suicide scale, suicide assessment, suicide risk, suicide attempt, suicide, suicidal ideation, suicidal behavior, suicidality, C-SSRS, FDA 2012 Draft Guidance Document [ C R I T I C A L R E V I E W ] by JENNIFER M. GIDDENS; KATHY HARNETT SHEEHAN, PhD; and DAVID V. SHEEHAN, MD, MBA J. Giddens is the Co-founder of the Tampa Center for Research on Suicidality, Tampa, Florida; Dr. K. Sheehan is Associate Professor Emeritus at the University of South Florida College of Medicine, Tampa, Florida; and Dr. D. Sheehan is Distinguished University Health Professor Emeritus at the University of South Florida College of Medicine, Tampa, Florida. Innov Clin Neurosci. 2014;11(9–10):66–80 The Columbia–Suicide Severity Rating Scale (C–SSRS): Has the "Gold Standard" Become a Liability?

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