Madan Alok, Frueh B Christopher, Allen Jon G, Ellis Thomas E, Rufino Katrina A, Oldham John M, Fowler J Christopher
12301 South Main St, Houston, TX 77035.
The Menninger Clinic, Houston, Texas, USA.
J Clin Psychiatry. 2016 Jul;77(7):e867-73. doi: 10.4088/JCP.15m10069.
Accurate prediction of suicide remains elusive due to lack of predictive measures. Given the Columbia-Suicide Severity Rating Scale's (C-SSRS) emerging "gold-standard" status for risk assessment, studies are needed to assess its psychometric properties, particularly predictive validity. The current study adds to the limited literature by assessing the C-SSRS's internal consistency, factor structure, concurrent validity, and predictive validity.
In this longitudinal study of 1,055 adults with DSM-IV diagnoses consecutively admitted to a specialized psychiatric hospital between July 1, 2012, and June 30, 2014, patients completed standardized assessments, including the C-SSRS, at admission and 2, 12, and 24 weeks postdischarge.
The C-SSRS evidenced excellent internal consistency (ordinal α = .95). Principal components analysis (PCA) revealed a 2-factor solution, accounting for 65.3% of the variance across items. The severity of ideation and behavioral items loaded onto the first factor, and the intensity of ideation items loaded onto the second factor. The total score, factors, and the most severe ideation single item were moderately correlated with other measures of suicidality (0.27 ≤ r ≤ 0.58; P < .0001). The summary score from the ideation/behavior factor was found to be modestly correlated with any suicide-related behavior within the 6 months following hospitalization. Receiver operator characteristics indicated that the C-SSRS performed adequately in correctly classifying any suicide-related behavior within 6 months of discharge from the hospital (AUC = 0.757, P < .001) with the total score and summary score from the ideation/behavior factor providing the best balance between sensitivity (0.694) and specificity (0.652-0.674).
This study is the first to assess the factor structure of the C-SSRS in a large, high-risk sample. The measure has solid psychometric properties and merits use as a suicide risk assessment measure.
由于缺乏预测手段，准确预测自杀仍然难以实现。鉴于哥伦比亚自杀严重程度评定量表（C-SSRS）在风险评估中日益凸显的“金标准”地位，需要开展研究来评估其心理测量特性，尤其是预测效度。本研究通过评估C-SSRS的内部一致性、因子结构、同时效度和预测效度，为有限的文献增添了内容。
在这项对2012年7月1日至2014年6月30日期间连续入住一家专业精神病医院的1055名患有DSM-IV诊断的成年人进行的纵向研究中，患者在入院时以及出院后2周、12周和24周完成了标准化评估，包括C-SSRS。
C-SSRS显示出出色的内部一致性（有序α = 0.95）。主成分分析（PCA）揭示了一个双因子解决方案，解释了各项目65.3%的方差。意念和行为项目的严重程度加载到第一个因子上，意念项目的强度加载到第二个因子上。总分、因子以及最严重的意念单项与其他自杀倾向测量指标呈中度相关（0.27≤r≤0.58；P <.0001）。意念/行为因子的汇总得分与住院后6个月内的任何自杀相关行为呈适度相关。受试者工作特征曲线表明，C-SSRS在正确分类出院后6个月内的任何自杀相关行为方面表现良好（AUC = 0.757，P <.001），意念/行为因子的总分和汇总得分在敏感性（0.694）和特异性（0.652 - 0.674）之间提供了最佳平衡。
本研究首次在一个大型高危样本中评估了C-SSRS的因子结构。该测量方法具有可靠的心理测量特性，值得用作自杀风险评估措施。
