title: The Predictive Validity of the Beck Depression Inventory Suicide Item.
abstract: OBJECTIVE
  The current study examines the predictive validity of the Beck Depression Inventory (BDI) suicide item for death by suicide and suicide attempts.
  
  
  METHODS
  The study included 2 samples: (1) 5,200 psychiatric outpatients who were evaluated between 1975 and 1995 and followed prospectively for up to 20 years (all psychiatric diagnoses based on DSM-III and DSM-III-R), and (2) 119 patients who, between 2000 and 2004, participated in a randomized controlled trial of outpatient Cognitive Therapy for Suicide Prevention after a suicide attempt and were followed for 18 months (all psychiatric diagnoses based on DSM-IV-TR). All patients completed structured diagnostic interviews, as well as the BDI and Scale for Suicide Ideation.
  
  
  RESULTS
  Cox regression models demonstrated that the BDI suicide item significantly predicted both deaths by suicide (Wald χ(2)1 = 35.67; P < .001 [N = 5,200]) and repeat suicide attempts (Wald χ(2)1 = 8.82; P < .01 [N = 119]), with each successive rating on the item conferring greater risk. Using receiver operating characteristic (ROC) curves, optimal cutoff scores of 1 and above for suicide and 2 and above for suicide attempts were identified as providing the best balance between sensitivity and specificity.
  
  
  CONCLUSIONS
  The BDI suicide item is associated with both risk of repeat suicide attempts and death by suicide. The use of the item as a brief, efficient screen for suicide risk in routine clinical care is recommended. Clinicians would then conduct a comprehensive suicide risk assessment in response to a positive screen. Future research examining the item's performance in other at-risk groups (ie, older adults, adolescents, inpatients, etc) is encouraged.
authors.affiliation: Department of Psychiatry, University of Pennsylvania, 3535 Market St, Room 2035, Philadelphia, PA, 19104-3309 kelgreen@mail.med.upenn.edu.
authors.forename: Kelly L
authors.initials: KL
authors.lastname: Green
authors.forename: Gregory K
authors.initials: GK
authors.lastname: Brown
authors.forename: Shari
authors.initials: S
authors.lastname: Jager-Hyman
authors.forename: Jason
authors.initials: J
authors.lastname: Cha
authors.forename: Robert A
authors.initials: RA
authors.lastname: Steer
authors.forename: Aaron T
authors.initials: AT
authors.lastname: Beck
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011569:Psychiatric Status Rating Scales / Q000592:standards*; D015203:Reproducibility of Results; D012306:Risk; D013405:Suicide; D013406:Suicide, Attempted; D055815:Young Adult