Binder Philippe, Heintz Anne-Laure, Servant Coralie, Roux Marie-Thérèse, Robin Stéphane, Gicquel Ludovic, Ingrand Pierre
Faculty of Medicine, Department of General Practice, Poitiers, France.
Rectory Poitiers Health Service, Poitiers, France.
Early Interv Psychiatry. 2018 Aug;12(4):637-644. doi: 10.1111/eip.12352. Epub 2016 May 6.
Adolescents at risk for suicide often see their general practitioner solely for somatic or administrative reasons. A simple screening test given during a conversation would be of substantial help to send a signal and tackle the problem. We propose to update a screening test previously validated in France - the TSTS-Cafard - because of significant changes in the lives of adolescents with the growth of the cyber world since 2000.
The design and setting was a cross-sectional study involving 912 15-year-old adolescents in 90 French schools. They completed a questionnaire that included the TSTS-Cafard and risk factors extracted from the Health Behaviour in School-Aged Children survey. To improve the test, we selected questions drawn from the recent literature. Answers were analysed according to 'suicidality' = at least one suicide attempt in life or suicidal ideation often over the past 12 months.
Suicidality rates were 9.6% for boys and 23.1% for girls. Although the TSTS-Cafard test was generally effective, one question was no longer discriminating. A new test, entitled 'BITS', included only four questions on bullying, insomnia, tobacco and stress, with three levels of response and scores ranging from 0 to 8. Improvement was achieved without loss of performance. Using a cut-off score of 3, we achieved 78% accuracy (area under the curve), 75% sensitivity and 70% specificity.
The BITS test could allow the question of suicide risk to be addressed during a routine check-up in primary care but the results need to be validated with 13 to 18-year olds.
有自杀风险的青少年常常仅因躯体或行政事务原因去看全科医生。在问诊过程中进行一项简单的筛查测试，对于发出警示信号并解决该问题会有很大帮助。鉴于自2000年以来随着网络世界的发展青少年的生活发生了重大变化，我们提议更新此前在法国验证过的一项筛查测试——TSTS-Cafard。
研究设计与设置为一项横断面研究，涉及法国90所学校的912名15岁青少年。他们完成了一份问卷，其中包括TSTS-Cafard以及从学龄儿童健康行为调查中提取的风险因素。为改进该测试，我们从近期文献中选取了一些问题。根据“自杀倾向”（即一生中至少有一次自杀未遂或在过去12个月中经常有自杀意念）对答案进行分析。
男孩的自杀倾向率为9.6%，女孩为23.1%。尽管TSTS-Cafard测试总体上是有效的，但有一个问题不再具有区分性。一项名为“BITS”的新测试仅包括关于欺凌、失眠、吸烟和压力的四个问题，有三个等级的回答，分数范围从0到8。在不降低性能的情况下实现了改进。使用3分的临界值，我们达到了78%的准确率（曲线下面积）、75%的灵敏度和70%的特异度。
BITS测试可以在初级保健的常规检查中解决自杀风险问题，但结果需要在13至18岁的青少年中进行验证。
