Detecting suicidality among adolescent outpatients: evaluation of trained clinicians' suicidality assessment against a structured diagnostic assessment made by trained raters.
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.
Holi
Matti Mikael
MM
Department of Mental Health and Alcohol Research, National Public Health Institute, Helsinki, Finland. matti.holi@hus.fi
Pelkonen
Mirjami
M
Karlsson
Linnea
L
Tuisku
Virpi
V
Kiviruusu
Olli
O
Ruuttu
Titta
T
Marttunen
Mauri
M
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