Cochrane-Brink K A, Lofchy J S, Sakinofsky I
Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
Gen Hosp Psychiatry. 2000 Nov-Dec;22(6):445-51. doi: 10.1016/s0163-8343(00)00106-7.
This study explores the usefulness of clinical rating scales in the assessment of suicidal risk in an urban psychiatric teaching hospital. Admission for clinically evaluated suicide risk was the outcome variable because actual suicide occurs rarely. Six clinical scales identified high-risk patients: the Modified SAD PERSONS scale, revised Beck Depression Inventory, Beck Anxiety Inventory, Beck Hopelessness Scale, Beck Scale for Suicidal Ideation (BSS), and the High-Risk Construct Scale (NEW). It was hypothesized that patients who scored highly on the clinical scales were more likely to be admitted. Five of the scales had previously established psychometric properties, while one was new and untested. For our patient population, the established scales had 100% sensitivity and negative predictive value, but lower specificity and positive predictive value (range = 38-90% & 28-71%). We performed a correlation matrix and regression analysis to determine which scale(s) best predicted admission based upon suicidal concerns. The previously untested NEW scale was the best predictor followed by the BSS. Clinical rating scales cannot predict suicide in the individual and strict cut-off scores should not be used to dictate admission to hospital. However, the information provided can be a valuable adjunct to suicide risk assessment in psychiatric and non-psychiatric emergency settings
本研究探讨了临床评定量表在一家城市精神科教学医院自杀风险评估中的效用。因实际自杀情况很少发生，故将经临床评估的自杀风险入院情况作为结果变量。六种临床量表可识别出高风险患者：改良版SAD PERSONS量表、修订版贝克抑郁量表、贝克焦虑量表、贝克绝望量表、贝克自杀意念量表（BSS）以及高风险构念量表（NEW）。研究假设在临床量表上得分高的患者更有可能入院。其中五种量表先前已确立心理测量特性，而有一种是新的且未经测试。对于我们的患者群体，已确立的量表具有100%的敏感性和阴性预测值，但特异性和阳性预测值较低（范围分别为38 - 90%和28 - 71%）。我们进行了相关矩阵和回归分析，以确定哪种量表能基于自杀相关担忧最准确地预测入院情况。先前未经测试的NEW量表是最佳预测指标，其次是BSS量表。临床评定量表无法预测个体的自杀行为，且不应使用严格的截止分数来决定是否入院。然而，所提供的信息在精神科和非精神科急诊环境中对自杀风险评估而言可能是有价值的辅助手段
