C‐SSRS performance in emergency department patients at high risk for suicide. Issue 6 (24th July 2020) - Brown, Lily A.
Abstract: Objective: To evaluate the psychometric and predictive performance of the Columbia‐Suicide Severity Rating Scale (C‐SSRS) in emergency department (ED) patients with suicidal ideation or attempts (SI/SA). Methods: Participants ( n = 1, 376, mean age 36.8, 55% female, 76.8% white) completed the C‐SSRS during the ED visit and were followed for one year. Reliability analyses, exploratory structural equation modeling, and prediction of future SA were explored. Results: Reliability of the Suicidal Ideation subscale was adequate, but was poor for the Intensity of Ideation and Suicidal Behavior subscales. Three empirically derived factors characterized the C‐SSRS. Only Factor 1 (Suicidal Ideation and Attempts) was a reliable predictor of subsequent SA, though odds ratios were small ( OR s: 1.09–1.10, CI95% : 1.04, 1.15). The original C‐SSRS Suicidal Ideation and Suicidal Behavior subscales and the C‐SSRS ED screen predicted subsequent SA, again with small odds ratios ( ORs : 1.07–1.19, CI95% : 1.01, 1.29). In participants without a SA history, no C‐SSRS subscale predicted subsequent SA. History of any SA ( OR : 1.98, CI95% : 1.43, 2.75) was the strongest predictor of subsequent SA. Conclusions: The psychometric evidence for the C‐SSRS was mixed. History of a prior SA, as measured by the C‐SSRS, provided the most parsimonious and powerful assessment for predicting future SA.