Concurrent validity and reliability of suicide risk assessment instruments: A meta analysis of 20 instruments across 27 international cohorts

Abstract

Objective A major limitation of current suicide research is the lack of power to identify robust correlates of suicidal thoughts or behaviour. Variation in suicide risk assessment instruments used across cohorts may represent a limitation to pooling data in international consortia. Method Here, we examine this issue through two approaches: (i) an extensive literature search on the reliability and concurrent validity of the most commonly used instruments; and (ii) by pooling data (N~6,000 participants) from cohorts from the ENIGMA-Major Depressive Disorder (ENIGMA-MDD) and ENIGMA-Suicidal Thoughts and Behaviour (ENIGMA-STB) working groups, to assess the concurrent validity of instruments currently used for assessing suicidal thoughts or behaviour. Results Our results suggested a pattern of moderate-to-high correlations between instruments, consistent with the wide range of correlations, r=0.22-0.97, reported in the literature. Two common complex instruments, the Columbia Suicide Severity Rating Scale (C-SSRS) and the Beck Scale for Suicidal Ideation (SSI), were highly correlated with each other (r=0.83), as were suicidal ideation items from common depression severity questionnaires. Conclusions Our findings suggest that multi-item instruments provide valuable information on different aspects of suicidal thoughts or behaviour, but share a core factor with single suicidal ideation items found in depression severity questionnaires. Multi-site collaborations including cohorts that used distinct instruments for suicide risk assessment should be feasible provided that they harmonise across instruments or focus on specific constructs of suicidal thoughts or behaviours.

Peer victimization (bullying) on mental health, behavioral problems, cognition, and academic performance in preadolescent children in the ABCD Study

“…Active suicidality was assessed in a similar regard in the past two weeks or ever, with questions about the child having thoughts of wanting to kill him/herself as well as actual suicide attempts. The interrater reliability of the KSADS suicide module was moderate to strong, with a kappa of 0.9 for ideation (passive or active), 0.83 for attempts, and 0.71 for NSSI (Campos et al, 2021). For suicidal ideation, the intraclass correlation coefficient (ICC) is 0.69 for test-retest reliability and 0.70 for parent-summary agreement (Chambers et al, 1985).…”

Structural brain alterations associated with suicidal thoughts and behaviors in young people: results across 21 international studies from the ENIGMA Suicidal Thoughts and Behaviours consortium

“…First, different instruments were used to assess STBs across cohorts for analyses in the larger ENIGMA-STB sample, although we used a detailed process to harmonize measures across studies. Moreover, when multiple instruments were used to assess suicidal ideation (thoughts) or attempts within one cohort, we defined STBs in that sample using instruments that showed strong correlations with the instruments used by other cohorts to assess STBs (39). Future multi-site collaborations would be improved by prospective harmonization in data collection and/or measurement.…”