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Cited by 1,025Suicide and Self-Harm StudiesTreatment of Major DepressionBipolar Disorder and Treatment

The DOI matches its Crossref record; 31 of the 31 references it cites were found in a registry or an index.

Columbia Classification Algorithm of Suicide Assessment (C-CASA): Classification of Suicidal Events in the FDA’s Pediatric Suicidal Risk Analysis of Antidepressants

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Posner, Kelly, Oquendo, Maria A., Gould, Madelyn, Stanley, Barbara, Davies, Mark·2007·American Journal of Psychiatry
DOI 10.1176/ajp.2007.164.7.1035PMC PMC3804920
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Abstract

Objective: To evaluate the link between antidepressants and suicidal behavior and ideation (suicidality) in youth, adverse events from pediatric clinical trials were classified in order to identify suicidal events. The authors describe the Columbia Classification Algorithm for Suicide Assessment (C-CASA), a standardized suicidal rating system that provided data for the pediatric suicidal risk analysis of antidepressants conducted by the Food and Drug Administration (FDA). Method: Adverse events (N=427) from 25 pediatric antidepressant clinical trials were systematically identified by pharmaceutical companies. Randomly assigned adverse events were evaluated by three of nine independent expert suicidologists using the Columbia classification algorithm. Reliability of the C-CASA ratings and agreement with pharmaceutical company classification were estimated. Results: Twenty-six new, possibly suicidal events (behavior and ideation) that were not originally identified by pharmaceutical companies were identified in the C-CASA, and 12 events originally labeled as suicidal by pharmaceutical companies were eliminated, which resulted in a total of 38 discrepant ratings. For the specific label of “suicide attempt,” a relatively low level of agreement was observed between the C-CASA and pharmaceutical company ratings, with the C-CASA reporting a 50% reduction in ratings. Thus, although the C-CASA resulted in the identification of more suicidal events overall, fewer events were classified as suicide attempts. Additionally, the C-CASA ratings were highly reliable (intraclass correlation coefficient [ICC]=0.89). Conclusions: Utilizing a methodical, anchored approach to categorizing suicidality provides an accurate and comprehensive identification of suicidal events. The FDA’s audit of the C-CASA demonstrated excellent transportability of this approach. The Columbia algorithm was used to classify suicidal adverse events in the recent FDA adult antidepressant safety analyses and has also been mandated to be applied to all anticonvulsant trials and other centrally acting agents and nonpsychotropic drugs.

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Crossref · 10.1176/ajp.2007.164.7.1035

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Research works printed but not linked: 9

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Metadata

Authors
Posner, K., Oquendo, M. A., Gould, M., Stanley, B., & Davies, M.
Affiliations
New York State Psychiatric Institute (US)
Corresponding author
Posner, Kelly
ORCID
Davies, Mark
Venue
American Journal of Psychiatry
Publisher
American Psychiatric Association Publishing
Published
2007-07
Volume
164
Issue
7
Pages
1035-1043
ISSN
  • 0002-953X (ISSN-L)
  • 1535-7228
DOI
10.1176/ajp.2007.164.7.1035
PMC
PMC3804920
OpenAlex
W2138959943
Cited by
1,025
References
31
Citations by year
2026: 29 · 2025: 67 · 2024: 47 · 2023: 60 · 2022: 54 · 2021: 93 · 2020: 68 · 2019: 53 · 2018: 41 · 2017: 51 · 2016: 63 · 2015: 45 · 2014: 69 · 2013: 53 · 2012: 58
FWCI
45.49
Type
journal article
Language
en
Open access
Locations
  • American Journal of Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institute on Alcohol Abuse and Alcoholism (P20AA015630)
  • National Institute of Mental Health (P50MH090964)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
  • Health Sciences › Medicine › Pharmacology (medical) › Treatment of Major Depression
  • Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
Keywords
suicidal ideation, suicidal behavior, suicide attempts, antidepressants, pediatric clinical trials, adverse event classification, rating reliability, youth suicidality
MeSH terms
Adolescent, Age Factors, Algorithms, Antidepressive Agents, Mental Disorders, Child, Depressive Disorder, Drug Industry, Female, Humans, Legislation, Drug, Male, Terminology as Topic, Placebos, Suicide, Suicide, Attempted, United States, United States Food and Drug Administration, Meta-Analysis as Topic, Reproducibility of Results, Randomized Controlled Trials as Topic, Risk Assessment

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