Concurrent validity and reliability of suicide risk assessment instruments: A meta analysis of 20 instruments across 27 international cohorts
Authors: Campos Adrian I. , Van Velzen Laura S. , Veltman Dick J. , Pozzi Elena , Ambrogi Sonia , Ballard Elizabeth D. , Banaj Nerisa , Başgöze Zeynep , Bellow Sophie , Benedetti Francesco , Bollettini Irene , Brosch Katharina , Canales-Rodríguez Erick J. , Clarke-Rubright Emily K. , Colic Lejla , Connolly Colm G. , Courtet Philippe , Cullen Kathryn R. , Dannlowski Udo , Dauvermann Maria R. , Davey Christopher G. , Deverdun Jeremy , Dohm Katharina , Erwin-Grabner Tracy , Fani Negar , Fortea Lydia , Fuentes-Claramonte Paola , Gonul Ali Saffet , Gotlib Ian H. , Grotegerd Dominik , Harris Mathew A. , Harrison Ben J. , Haswell Courtney C. , Hawkins Emma L. , Hill Dawson , Hirano Yoshiyuki , Ho Tiffany C. , Jollant Fabrice , Jovanovic Tanja , Kircher Tilo , Klimes-Dougan Bonnie , le Bars Emmanuelle , Lochner Christine , McIntosh Andrew M. , Meinert Susanne , Mekawi Yara , Melloni Elisa , Mitchell Philip , Morey Rajendra A. , Nakagawa Akiko , Nenadić Igor , Olié Emilie , Pereira Fabricio , Phillips Rachel D. , Piras Fabrizio , Poletti Sara , Pomarol-Clotet Edith , Radua Joaquim , Ressler Kerry J. , Roberts Gloria , Rodriguez-Cano Elena , Sacchet Matthew D. , Salvador Raymond , Sandu Anca-Larisa , Shimizu Eiji , Singh Aditya , Spalletta Gianfranco , Steele J. Douglas , Stein Dan J. , Stein Frederike , Stevens Jennifer S. , Teresi Giana I. , Uyar-Demir Aslihan , van der Wee Nic J. , van der Werff Steven J. , van Rooij Sanne J.H. , Vecchio Daniela , Verdolini Norma , Vieta Eduard , Waiter Gordon D. , Whalley Heather , Whittle Sarah L. , Yang Tony T. , Zarate Carlos A. , Thompson Paul M. , Jahanshad Neda , Harmelen Anne-Laura van , Blumberg Hilary P. , Schmaal Lianne , Rentería Miguel E. 
Published: September 2021

Objective

A major limitation of current suicide research is the lack of power to identify robust correlates of suicidal thoughts or behaviour. Variation in suicide risk assessment instruments used across cohorts may represent a limitation to pooling data in international consortia.

Method

Here, we examine this issue through two approaches: (i) an extensive literature search on the reliability and concurrent validity of the most commonly used instruments; and (ii) by pooling data (N∼6,000 participants) from cohorts from the ENIGMA-Major Depressive Disorder (ENIGMA-MDD) and ENIGMA-Suicidal Thoughts and Behaviour (ENIGMA-STB) working groups, to assess the concurrent validity of instruments currently used for assessing suicidal thoughts or behaviour.

Results

Our results suggested a pattern of moderate-to-high correlations between instruments, consistent with the wide range of correlations, r=0.22-0.97, reported in the literature. Two common complex instruments, the Columbia Suicide Severity Rating Scale (C-SSRS) and the Beck Scale for Suicidal Ideation (SSI), were highly correlated with each other (r=0.83), as were suicidal ideation items from common depression severity questionnaires.

Conclusions

Our findings suggest that multi-item instruments provide valuable information on different aspects of suicidal thoughts or behaviour, but share a core factor with single suicidal ideation items found in depression severity questionnaires. Multi-site collaborations including cohorts that used distinct instruments for suicide risk assessment should be feasible provided that they harmonise across instruments or focus on specific constructs of suicidal thoughts or behaviours.

Key points

Question: To inform future suicide research in multi-site international consortia, it is important to examine how different suicide measures relate to each other and whether they can be used interchangeably.

Findings: Findings suggest detailed instruments (such as the Columbia Suicide Severity Rating Scale and Beck Scale for Suicidal Ideation) provide valuable information on suicidal thoughts and behaviour, and share a core factor with items on suicidal ideation from depression severity rating scale (such as the Hamilton Depression Rating Scale or the Beck Depression Inventory).

Importance: Results from international collaborations can mitigate biases by harmonising distinct suicide risk assessment instruments.

Next steps: Pooling data within international suicide research consortia may reveal novel clinical, biological and cognitive correlates of suicidal thoughts and/or behaviour.