Evidence-based guidelines for the interpretation of the 9-item Concise Health Risk Tracking – Self-Report (CHRT-SR₉) measure of suicidal risk

Abstract

Background: The 9-item Concise Health Risk Tracking – Self-Report (CHRT-SR9) is a widely used patient-reported outcome measure of suicidal risk. The goal of this article is to provide an evidence-based interpretation of the CHRT-SR9 total score in terms of four clinically actionable categories of suicidal risk (none, mild, moderate, and severe). Methods: Data from two large programs involving adolescents and adults were combined in this paper. In these studies, the CHRT-SR9 was anchored against an independent measure of suicidal risk, the suicide item (Item #9) in the Patient Health Questionnaire (PHQ-9), with categories 0 (none), 1 (mild), 2 (moderate), and 3 (severe). In the combined data ( n = 1945), we calculated the cumulative percentage of data across these four categories and the percentile score of the CHRT-SR9 total score that corresponded to these percentages; from this, we developed ranges of the CHRT-SR9 total score that corresponded to the four categories of Item #9 of PHQ-9. We also calculated similar ranges for two broad subscales of the CHRT-SR9 total score; Propensity and Suicidal Thoughts. To assess the robustness of our findings, we repeated the analysis at another timepoint across studies. Results: Findings indicated that the CHRT-SR9 total score (range: 0–36) can be categorized as none (0–14), mild (15–21), moderate (22–26), and severe (27–36). Similar categories were calculated for the Propensity and Suicidal Thoughts subscales. The findings were the same when repeated at another timepoint. Conclusion: This categorization of the CHRT-SR9 total score can place patients into clinically meaningful and actionable categories of suicidal risk.