Department of Psychology, University of North Carolina at Chapel Hill, CB #3270, Davie Hall, Chapel Hill, NC 27599-3270
J Clin Psychiatry. 2015 Dec;76(12):1676-82. doi: 10.4088/JCP.14m09353.
Compare the accuracy, agreement, internal consistency, and interrater reliability of 3 interviews to assess suicidal ideation and behavior in accordance with US Food and Drug Administration guidance about reporting categories.
Adults admitted to a psychiatric inpatient unit (N = 199) completed 3 assessments of past month and lifetime suicidal ideation and behavior-the Columbia Suicide Severity Rating Scale (C-SSRS), the Suicide Tracking Scale (STS), and the Sheehan Suicidality Tracking Scale (S-STS)-in randomized, counterbalanced order. "Missing gold standard" latent class analyses defined categories for ideation and behavior. Analyses also evaluated the S-STS mapping to C-SSRS categories. Three trained judges re-rated 89 randomly selected interview videotapes. Cohen κ, the primary outcome measure, quantified agreement above chance. Data were collected between November 2011 and June 2013.
All 3 assessments showed excellent accuracy for suicidal ideation (κ = 0.72 to 1.00) and attempts (κ = 0.82 to 0.95) calibrated against latent classes. Interrater agreement ranged from κ = 0.52 to 1.00. Interrater agreement about more granular C-SSRS categories varied more widely (κ = 0.48 to 1.00), and the C-SSRS and S-STS assigned significantly different numbers of cases to many categories. Cronbach α was < 0.55 for the C-SSRS ideation and between 0.78 and 0.92 for the other scales.
All 3 assessments showed good accuracy for broad categories of suicidal ideation and behavior. More granular, specific categories usually were rated reliably, but the C-SSRS and S-STS differed significantly in regard to which patients were assigned to these subcategories. Using any of these interviews would improve reliability over unstructured assessment in evaluating suicidal ideation and behavior. Clinical predictive validity of these interviews, and particularly the more granular categories, remains to be shown.
根据美国食品和药物管理局关于报告类别指南，比较 3 种访谈评估自杀意念和行为的准确性、一致性、内部一致性和评分者间可靠性。
199 名成年精神科住院患者（N=199）按随机、交叉平衡顺序完成 3 次过去 1 个月和终生自杀意念和行为评估，包括哥伦比亚自杀严重程度评定量表（C-SSRS）、自杀跟踪量表（STS）和 Sheehan 自杀跟踪量表（S-STS）。“缺失黄金标准”潜类别分析定义了意念和行为类别。分析还评估了 S-STS 与 C-SSRS 类别的映射。3 名经过培训的评审员对 89 个随机选择的访谈录像进行了重新评分。主要评估指标 Cohen κ 量化了超过机会的一致性。数据收集于 2011 年 11 月至 2013 年 6 月。
所有 3 种评估对自杀意念（κ=0.72 至 1.00）和自杀企图（κ=0.82 至 0.95）的准确性均表现出色，与潜类别相校准。评分者间的一致性范围从κ=0.52 至 1.00。关于更精细的 C-SSRS 类别的评分者间一致性差异更大（κ=0.48 至 1.00），并且 C-SSRS 和 S-STS 将明显不同数量的病例分配到许多类别。C-SSRS 意念的 Cronbach α<0.55，而其他量表的 Cronbach α 值在 0.78 至 0.92 之间。
所有 3 种评估对自杀意念和行为的广泛类别均表现出良好的准确性。更精细、具体的类别通常可靠地评分，但 C-SSRS 和 S-STS 在将哪些患者分配到这些子类别方面存在显著差异。与非结构化评估相比，使用这些访谈中的任何一种都可以提高评估自杀意念和行为的可靠性。这些访谈，特别是更精细的类别，其临床预测效度仍有待证明。
