Research Unit INSIDE, University of Luxembourg, Luxembourg.
Research Unit INSIDE, University of Luxembourg, Luxembourg.
J Affect Disord. 2020 Jan 1;260:61-66. doi: 10.1016/j.jad.2019.08.025. Epub 2019 Aug 15.
BACKGROUND: Suicide is the second leading cause of death in adolescents. Screening for persons at risk usually includes asking about suicidal ideation, which is considered inappropriate in some societies and situations. To avoid directly addressing suicide, this paper investigates whether the Health Behaviour in School-aged Children Symptom Checklist (HBSC-SCL), a validated non-clinical measure of eight subjective health complaints (e.g. headache, feeling low), could be used as a tool for screening suicidal ideation and behavior in adolescents. METHODS: 5262 secondary school students aged 12-18 answered the Luxembourgish HBSC 2014 survey, including the HBSC-SCL items and suicidal ideation and behavior questions. RESULTS: Each HBSC-SCL item correlates with suicidal ideation and behavior. A sum score was calculated ranging from zero to eight health complaints to predict respondents who considered suicide (area under the ROC curve = 0.770). The ideal cut-off for screening students who consider suicide is three or more health complaints: sensitivity is 66.3%, specificity is 75.9% and positive predictive value is 32.9%. LIMITATIONS: One limitation is HBSC-SCL's low positive predictive value. This is a general problem of screening rare events: the lower the prevalence, the lower the positive predictive value. Sensitivity and specificity could be improved by taking age-, gender- and country-specific cut-off values, but such refinements would make the score calculation more complicated. CONCLUSIONS: The HBSC-SCL is short, easy to use, with satisfactory screening properties. The checklist can be used when suicide cannot be addressed directly, and also in a more general context, e.g. by school nurses when screening adolescents.
背景:自杀是青少年人群的第二大死亡原因。对自杀风险人群的筛查通常包括询问自杀意念,然而在某些社会和情况下,这种做法并不合适。为避免直接涉及自杀问题,本文研究了健康行为在青少年儿童症状检查表(HBSC-SCL),一种经过验证的非临床衡量 8 种主观健康问题的方法(例如头痛、情绪低落),是否可以作为筛查青少年自杀意念和行为的工具。
方法:5262 名 12-18 岁的中学生回答了卢森堡 2014 年 HBSC 调查,其中包括 HBSC-SCL 项目以及自杀意念和行为问题。
结果:每个 HBSC-SCL 项目都与自杀意念和行为相关。计算了一个总分,范围从 0 到 8 个健康问题,以预测考虑自杀的受访者(ROC 曲线下面积为 0.770)。筛查考虑自杀的学生的理想切点为 3 个或更多健康问题:敏感性为 66.3%,特异性为 75.9%,阳性预测值为 32.9%。
局限性:一个限制是 HBSC-SCL 的阳性预测值较低。这是筛查罕见事件的一般问题:患病率越低,阳性预测值越低。通过采用年龄、性别和国家特定的切点值,可以提高敏感性和特异性,但这种细化会使评分计算更加复杂。
结论:HBSC-SCL 简短、易于使用,具有令人满意的筛查特性。当不能直接解决自杀问题时,可以使用检查表,也可以在更广泛的背景下使用,例如学校护士在筛查青少年时使用。
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