Development of a Computerized Adaptive Test Suicide Scale—The CAT-SS
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OBJECTIVE: Current suicide risk screening and measurement are inefficient, have limited measurement precision, and focus entirely on suicide-related items. For this study, a psychometric harmonization between related suicide, depression, and anxiety symptom domains that provides a more balanced and complete spectrum of suicidal symptomatology was developed. The objective of this article is to describe the results of the early stages of computerized adaptive testing development for a suicide scale and pave the way for the final stage of validation. METHODS: Data from psychiatric outpatients at the University of Pittsburgh and a community health clinic were collected from January 2010 through June 2012. 789 participants were enrolled in the calibration phase; 70% were female, and 30% were male. The rate of major depressive disorder as diagnosed by DSM-5 was 47%. The item bank contained 1,008 items related to depression, anxiety, and mania, including 11 suicide items. Data were analyzed using a bifactor model to identify a core dimension between suicidal ideation, depression, anxiety, and mania items. A computerized adaptive test was developed via simulation from the actual complete item responses in 308 subjects. RESULTS: 111 items were identified that provided an extension of suicidality assessment to include statistically related responses from depression and anxiety domains that are syndromally associated with suicidality. All items had high loadings on the primary suicide dimension (average = 0.67; range, 0.49-0.88). Analyses revealed that a mean of 10 items (5-20) had a correlation of 0.96 with the 111-item scale, with a precision of 5 points on a 100-point scale metric. Preliminary validation data based on 290 clinician interviews revealed a 52-fold increase in the likelihood of current suicidal ideation across the range of the Computerized Adaptive Test Suicide Scale (CAT-SS). CONCLUSIONS: The CAT-SS is able to accurately measure the latent suicide dimension with a mean of 10 items in approximately 2 minutes. Further validation against an independent clinician-administered assessment of suicide risk (ideation and attempts) and prediction of suicidal behavior is underway.
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A CAT for the detection of suicidal ideation and behaviour has been developed using a sample of adult outpatients with a pre-existing mental health condition, and has demonstrated strong discriminative validity, with both high sensitivity and sensitivity in the identification of individuals at moderate and high risk for suicidal behaviour in the ED.
“A CAT for the detection of suicidal ideation and behaviour has been developed using a sample of adult outpatients with a pre-existing mental health condition, and has demonstrated strong discriminative validity, with both high sensitivity and sensitivity in the identification of individuals at moderate and high risk for suicidal behaviour in the ED 218 .”
From Suicide and suicide risk (2019) · cites this paper as [218]
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Experimental — accuracy not yet measuredA CAT for assessing suicidal ideation or behavior has been developed for children and adolescents that shows high convergent and discriminative validity.
“Similarly, a CAT for assessing suicidal ideation or behavior has been developed for children and adolescents that shows high convergent and discriminative validity.”
From Suicide and suicide risk (2019) · cites this paper as [218]
The Discussion reports that the CAT-SS tracks clinician-rated suicidal ideation and is associated with lifetime suicide attempts, supporting the claim that the test was developed and showed validity for assessing suicidality. But Methods > Setting and Participants specifies treatment-seeking outpatients aged 18–80, not children or adolescents. The paper therefore does not support the claimed population. (LLM, conf=0.90)
Experimental — accuracy not yet measuredPredictive validity of both the adult and paediatric CATs for assessment of suicidal risk have yet to be reported.
“However, predictive validity of both the adult and paediatric CATs for assessment of suicidal risk have yet to be reported 218,219 .”
From Suicide and suicide risk (2019) · cites this paper as [218]
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Cited by 65
Research works printed but not linked: 11
- [4]Beck AT, Steer RA. BSI, Beck Scale for Suicide Ideation: Manual. San Antonio, TX: Pearson; 1991.
- [5]Davidson CL, Wingate LRR, Grant DM, Interpersonal suicide risk and ideation: the influence of depression and social anxiety. J Soc Clin Psychol. 2011; 30(8): 842– 855.
- [11]Lord FM, Novick MR. Statistical Theories of Mental Test Scores. Reading, MA: Addison-Welsley Publishing Company; 1968.
- [12]Traub R Classical test theory in historical perspective. Educational Measures: Issues and Practice. 1997; 16(4): 8– 14.
- [13]Meijer RR, Nering ML. Computerized adaptive testing: overview and introduction. Appl Psychol Meas. 1999; 23(3): 187– 194.
- [16]Gibbons RD, Bock D, Hedeker D, Full-information item bifactor analysis of graded response data. Appl Psychol Meas. 2007; 31(1): 4– 19.
- [18]Gibbons RD, Hedeker D. Full information item bi-factor analysis. Psychometrika. 1992; 57(3): 423– 436.
- [20]Cochran WG, Cox GM. Experimental Designs. New York, NY: Wiley; 1957.
- [22]Bock RD, Aitkin M. Marginal maximum likelihood estimation of item parameters: application of an EM algorithm. Psychometrika. 1981; 46(4): 443– 459.
- [23]Breiman L Random forests. Mach Learn. 2001; 45(1): 5– 32.
- [25]Thissen D, Steinberg L, Wainer H. Detection of differential item functioning using the parameters of item response models. In: Holland P, Wainer H, eds. Differential Item Functioning. Hillsdale, NJ: Lawrence Erlbaum Associates, Inc; 1993: 67– 100.
- Authors
- Gibbons, R. D., Kupfer, D., Frank, E., Moore, T., Beiser, D. G., & Boudreaux, E. D.
- Affiliations
- University of Chicago (US)
- University of Pittsburgh (US)
- University of Pittsburgh Medical Center (US)
- University of Massachusetts Chan Medical School (US)
- Corresponding author
- Gibbons, Robert D.
- Venue
- The Journal of Clinical Psychiatry
- Publisher
- Physicians Postgraduate Press, Inc
- Published
- 2017-12-27
- Volume
- 78
- Issue
- 9
- Pages
- 1376-1382
- ISSN
- 0160-6689 (ISSN-L)
- PMC
- PMC11986876
- OpenAlex
- W2612262780
- Cited by
- 65
- References
- 0
- Citations by year
- 2026: 6 · 2025: 7 · 2024: 4 · 2023: 11 · 2022: 7 · 2021: 12 · 2020: 4 · 2019: 8 · 2018: 5 · 2017: 1
- FWCI
- 6.11
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- The Journal of Clinical Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- The Journal of the American Medical Association (JAMA) Network (American Medical Association) (submittedVersion)
- Funders
- National Institute of Mental Health (R01MH066302)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Social Sciences › Decision Sciences › Management Science and Operations Research › Psychometric Methodologies and Testing
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- computerized adaptive testing, suicide risk screening, suicidal ideation, depression, anxiety, mania, bifactor model, item bank, psychiatric outpatients, measurement precision
- MeSH terms
- Suicide Prevention, Adolescent, Adult, Aged, Aged, 80 and over, Anxiety, Depression, Diagnosis, Computer-Assisted, Female, Humans, Male, Middle Aged, Psychiatric Status Rating Scales, Psychometrics, Suicide, Reproducibility of Results, Young Adult, Suicidal Ideation
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