title: Structured assessment of suicide risk in a psychiatric emergency service: Psychometric evaluation of the Nurses' Global Assessment of Suicide Risk scale (NGASR).
abstract: BACKGROUND
  Risk of suicide is notoriously difficult to assess, and no gold standard is available, in terms of an instrument of first choice. Many different instruments are in use, among which are some that are not properly psychometrically investigated.
  
  
  OBJECTIVE
  The aim of this study is to establish the psychometric properties of the Dutch version of the Nurses' Global Assessment of Suicide Risk scale (NGASR), and the feasibility of its use in assessing suicide risk. Therefore, our research questions are as follows: what is the reliability, validity, interpretability and feasibility of the NGASR?
  
  
  METHODS
  A psychometric study of acceptability, reliability and predictive validity among 252 patients making use of a concurrent instrument, the Suicide Intention Scale (SIS), concurrent assessment by a physician and 6-month follow-up.
  
  
  RESULTS
  Factor analysis identified five factors. Cronbach's alpha was .45. Intraclass correlation was .92 (95% confidence interval (CI) = .85-.95). Association between total NGASR and SIS was substantial and significant (B = 0.66, standard error of mean (SE) = 0.19, ß = .66, p = .003). NGASR total score had a significant and moderately strong association with judgement by a physician on 'suicidal thoughts' (odds ratio (OR) = 1.24, p = < .001) or 'suicidal thoughts or plans' (OR = 1.35, p = .001). No significant association of NGASR scores and 6-month follow-up of suicidality was found.
  
  
  CONCLUSIONS
  Internal consistency of the NGASR and most of the subscales identified was low. Other indicators of reliability of the NGASR were sufficient, although predictive validity was poor. The NGASR did not outperform other instruments but is easy to use, and may contribute to identification of risk factors, as well as to a more integral assessment of suicide risk.
authors: Department of Emergency Psychiatry, Altrecht Mental Health Care, Utrecht, The Netherlands Research Group for Social Psychiatry & Mental Health Nursing, HAN University of Applied Sciences, Nijmegen, The Netherlands m.van.veen@altrecht.nl.
authors: Mark
authors: M
authors: van Veen
authors: Department of Emergency Psychiatry, Altrecht Mental Health Care, Utrecht, The Netherlands.
authors: Inge
authors: I
authors: van Weeghel
authors: Research Group for Social Psychiatry & Mental Health Nursing, HAN University of Applied Sciences, Nijmegen, The Netherlands.
authors: Bauke
authors: B
authors: Koekkoek
authors: Department of Emergency Psychiatry, Altrecht Mental Health Care, Utrecht, The Netherlands University of Humanistic Studies, Utrecht, The Netherlands.
authors: Arjan W
authors: AW
authors: Braam
mesh_terms: D000293:Adolescent; D000328:Adult; D004637:Emergency Services, Psychiatric; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D007802:Language; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D011569:Psychiatric Status Rating Scales / Q000592:standards*; D011594:Psychometrics; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D013405:Suicide / Q000523:psychology*; D055815:Young Adult
keywords: Validity; community psychiatric nurse; psychiatric emergency service; reliability; risk assessment; suicidality