Giddens Jennifer M, Sheehan Kathy Harnett, Sheehan David V
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 Sep;11(9-10):66-80.
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.
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.
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 algorithm for suicidal ideation and behavior.
The evidence suggests that the Columbia-Suicide Severity Rating Scale is conceptually and psychometrically flawed and does not map to the Food and Drug Administration's new standards. A new gold standard for assessment of suicidality may be warranted.
哥伦比亚自杀严重程度评定量表已成为临床试验中评估自杀意念和行为的金标准。对该工具的批评声越来越多。我们研究该工具是否符合广泛接受的心理测量标准，并与美国食品药品监督管理局2012年最新的自杀现象评估算法相对应。我们的目标是确定哥伦比亚自杀严重程度评定量表是否应继续作为评估自杀意念和行为的首选工具。
标准的心理测量标准规定，为避免I型和II型错误进行的分类应全面，并涵盖现象的整个范围（即所有维度）。这些标准还应定义明确且一致，并且通篇措辞应清晰明了。我们根据这些标准来研究哥伦比亚自杀严重程度评定量表。
哥伦比亚自杀严重程度评定量表未涵盖自杀意念或行为的整个范围。因此，它有可能遗漏临床实践中呈现给临床医生的许多自杀意念和行为组合（II型错误）。潜在的错误分类（I型和II型错误）因有缺陷的导航说明、类别标题、定义和探查问题不匹配以及易产生多种解释的措辞而更加复杂。此外，当前形式的哥伦比亚自杀严重程度评定量表与2012年美国食品药品监督管理局自杀意念和行为的分类算法草案不对应。
证据表明，哥伦比亚自杀严重程度评定量表在概念和心理测量方面存在缺陷，并且与美国食品药品监督管理局的新标准不对应。可能需要一个评估自杀倾向的新金标准。
