Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City, NY USA; Department of Psychiatry, Schneider Children's Medical Center of Israel, Tel Aviv University, Tel Aviv, Israel.
Department of Psychiatry and Behavioral Health, Mount Sinai Beth Israel Medical Center, New York City, NY USA.
J Affect Disord. 2020 Nov 1;276:183-190. doi: 10.1016/j.jad.2020.06.053. Epub 2020 Jul 15.
The Suicide Crisis Syndrome (SCS) describes a pre-suicidal mental state marked by entrapment accompanied by affective disturbances, loss of cognitive control, hyperarousal and social withdrawal. This study tested the consistency and validity of the Suicide Crisis Inventory (SCI), a proposed measure of SCS severity, amongst a large, heterogeneous patient sample.
The SCI was used to assess 867 adult psychiatric inpatients and outpatients. Confirmatory factor analysis, logistic regressions and area under the curve analyses (AUC) were used to examine internal structure, construct validity and predictive validity for suicide ideation, plan and attempt one-month post-assessment.
The five-factor model of the SCS demonstrated good fit and excellent internal consistency. SCI scores indicated significant associations but non-redundancy with depression, anxiety, and independence from other dimensions of psychiatric distress. SCI scores specifically predicted suicide attempts with an AUC of 0.733 and odds ratio=8.62 (p<0.001) at optimal cut-off point. SCI incremental predictive validity over and beyond suicidal ideation and attempts history reported at baseline was supported for predicting suicide attempts (β= 0.012, S.E = 0.006; p=0.046).
The SCI is subject to self-report bias and does not include the SCS social withdrawal component. Follow-up assessment retention was partial (68%, n=591).
The SCI is validated as a tool for the assessment of the SCS intensity and of imminent suicidal behavior. The SCI is suggested as a tool that could aid both researchers and clinicians in comprehensive assessment of a pre-suicidal mental state within moderate to high-risk populations, regardless of self-report on suicidal intent.
自杀危机综合征（SCS）描述了一种自杀前的精神状态，其特征是伴有情绪障碍、认知控制丧失、过度警觉和社会退缩的困境。本研究在一个大型、异质的患者样本中测试了自杀危机量表（SCI）作为 SCS 严重程度的一种测量方法的一致性和有效性。
SCI 用于评估 867 名成年精神病住院患者和门诊患者。使用验证性因素分析、逻辑回归和曲线下面积分析（AUC）来检验 SCS 的内部结构、结构有效性和对自杀意念、计划和尝试的一个月后评估的预测有效性。
SCS 的五因素模型表现出良好的拟合度和极好的内部一致性。SCI 评分与抑郁、焦虑以及与其他精神痛苦维度的独立性有显著关联，但并非冗余。SCI 评分特别预测了自杀企图，其 AUC 为 0.733，最佳截断点处的优势比=8.62（p<0.001）。在预测自杀企图方面，SCI 对自杀意念和基线时报告的自杀企图史的增量预测有效性得到了支持（β=0.012，S.E=0.006；p=0.046）。
SCI 受到自我报告偏差的影响，且不包括 SCS 的社会退缩成分。随访评估的保留率是部分的（68%，n=591）。
SCI 被验证为评估 SCS 强度和即将发生的自杀行为的工具。建议将 SCI 作为一种工具，无论是否报告自杀意图，它都可以帮助研究人员和临床医生对中高危人群的自杀前心理状态进行全面评估。
