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Multimethod Assessment of Suicidality in Adolescent Psychiatric Inpatients: Preliminary Results

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ABSTRACT

Objective

To examine agreement among multiple assessments of adolescent suicidal ideation and suicidal behavior for adolescent psychiatric inpatients, including pencil/paper checklists; structured and unstructured interviews; and adolescent, clinician, and parent reports, and to provide suggestions for the accurate and reliable assessment of suicidality in adolescence.

Method

Participants included 153 adolescent psychiatric inpatients (54 boys, 99 girls) between the ages of 12 and 17 years. Measurement of suicidal ideation and behavior included common assessment instruments and standard clinical practices, including the Suicidal Ideation Questionnaire, NIMH Diagnostic Interview Schedule for Children, clinician interview, and parent report (Behavior Assessment Scale for Children).

Results

Results revealed significantly different rates of suicidality across each instrument and poor to moderate agreement between similar measures of adolescent suicidal ideation and suicidal behavior. Agreement between measures was generally best for boys, for older adolescents, and for assessments relying on a single informant. Reporters were most likely to agree on the presence of suicidality for more severely suicidal adolescents; this finding suggests that agreement in itself may be a useful marker for adolescent suicide.

Conclusions

Results of this preliminary study supported the use of multiple measurement approaches when examining adolescent suicidality, particularly those that rely on clinician judgment and adolescents’ own reports. Implications for future research and for clinical practice are also discussed.

Section snippets

Participants

Participants included 153 adolescents (54 boys, 99 girls) aged 12 to 17 years (mean = 14.8 years, SD = 1.6) who were admitted to an adolescent psychiatric inpatient unit in New England. The ethnic composition of the sample reflected hospital admission rates: 72.9% white, 10.4% Hispanic, 4.2% African American, and 12.5% mixed ethnicity/other. According to state census tract data, socioeconomic status levels for adolescents in this sample were high (15.6%), moderate (39.2%), low (17.6%), poverty

Rate of Suicidal Ideation and Behaviors by Assessment Instrument

Before examining the agreement between measures of suicidality, we examined the rate of suicidal ideation and behavior according to each measure in preliminary analyses. These data offer preliminary information on how conservative each of these measures is when screening for suicidality in adolescent inpatients. Table 1 lists the number and percentage of adolescents who were identified as exhibiting suicidal ideation and behavior according to each instrument for the entire sample, as well as

DISCUSSION

The accurate and efficient assessment of suicidal ideation and suicidal behavior is crucial for both clinical and scientific endeavors, yet there are currently few data available on the concordance between commonly used instruments designed to measure adolescent suicidality. This study provides initial empirical data on the agreement between measures of suicidal ideation and suicidal behavior in a sample of adolescent psychiatric inpatients, and it is the first to compare measures that use

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  • Cited by (0)

    This work was supported in part by NIMH National Research Service Award F32-MH11770 to the first author. Special thanks to Dana Damiani and Joy Richmond for their assistance in data collection.

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