title: Detecting suicidality among adolescent outpatients: evaluation of trained clinicians' suicidality assessment against a structured diagnostic assessment made by trained raters.
abstract: BACKGROUND
  Accurate assessment of suicidality is of major importance. We aimed to evaluate trained clinicians' ability to assess suicidality against a structured assessment made by trained raters.
  
  
  METHODS
  Treating clinicians classified 218 adolescent psychiatric outpatients suffering from a depressive mood disorder into three classes: 1-no suicidal ideation, 2-suicidal ideation, no suicidal acts, 3-suicidal or self-harming acts. This classification was compared with a classification with identical content derived from the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS-PL) made by trained raters. The convergence was assessed by kappa- and weighted kappa tests.
  
  
  RESULTS
  The clinicians' classification to class 1 (no suicidal ideation) was 85%, class 2 (suicidal ideation) 50%, and class 3 (suicidal acts) 10% concurrent with the K-SADS evaluation (gamma2 = 37.1, df 4, p = 0.000). Weighted kappa for the agreement of the measures was 0.335 (CI = 0.198-0.471, p < 0.0001). The clinicians under-detected suicidal and self-harm acts, but over-detected suicidal ideation.
  
  
  CONCLUSIONS
  There was only a modest agreement between the trained clinicians' suicidality evaluation and the K-SADS evaluation, especially concerning suicidal or self-harming acts. We suggest a wider use of structured scales in clinical and research settings to improve reliable detection of adolescents with suicidality.
authors.affiliation: Department of Mental Health and Alcohol Research, National Public Health Institute, Helsinki, Finland. matti.holi@hus.fi
authors.forename: Matti Mikael
authors.initials: MM
authors.lastname: Holi
authors.forename: Mirjami
authors.initials: M
authors.lastname: Pelkonen
authors.forename: Linnea
authors.initials: L
authors.lastname: Karlsson
authors.forename: Virpi
authors.initials: V
authors.lastname: Tuisku
authors.forename: Olli
authors.initials: O
authors.lastname: Kiviruusu
authors.forename: Titta
authors.initials: T
authors.lastname: Ruuttu
authors.forename: Mauri
authors.initials: M
authors.lastname: Marttunen
mesh_terms: D000293:Adolescent; D000553:Ambulatory Care; D003866:Depressive Disorder / Q000175:diagnosis* / Q000523:psychology; D005260:Female; D005387:Finland; D006801:Humans; D007318:Inservice Training; D007406:Interview, Psychological; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D010552:Personality Assessment / Q000706:statistics & numerical data*; D011594:Psychometrics / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D016728:Self-Injurious Behavior / Q000175:diagnosis* / Q000523:psychology; D013405:Suicide / Q000523:psychology; D013406:Suicide, Attempted / Q000517:prevention & control* / Q000523:psychology; D000092864:Suicide Prevention