title: Development and psychometric testing of the triggers of Suicidal Ideation Inventory for assessing older outpatients in primary care settings.
abstract: OBJECTIVE
  The purpose of this study was to develop an instrument for assessing triggers of suicidal ideation among older outpatients and determine its psychometrics.
  
  
  METHODS
  Participants were recruited from older outpatients of two hospitals in northern Taiwan. The 34-item Triggers of Suicidal Ideation Inventory (TSII) was developed, and its items were validated by experts in two runs of Delphi technique survey. Pre-testing this TSII in 200 older outpatients resulted in a 12-item TSII, with three items not considered triggers but suggesting the need for further psychiatric assessment. The 9-item TSII was examined by criterion validity, construct validity, internal consistency reliability, and test-retest reliability.
  
  
  RESULTS
  Factor analysis of the final version of TSII yielded a three-factor solution, accounting for 68.75% of the variance. Participants with depressive tendency tended to have higher TSII scores than participants with no depressive tendency (t = 8.62, p < 0.01), indicating good construct validity. TSII scores were significantly and positively correlated with Beck Scale for Suicide Ideation (r = 0.45, p < 0.01) and UCLA Loneliness (r = 0.55, p < 0.01) scores, indicating satisfactory criterion validity. The TSII had Cronbach's α and intraclass correlation coefficient of 0.70 and 0.99, respectively, indicating acceptable internal consistency reliability and excellent test-retest reliability. Receiver operating characteristic analysis revealed an area under the curve of 0.82, indicating excellent ability to detect triggers of suicidal ideation. With a cutoff point of 2, the sensitivity and specificity were 0.76 and 0.69, respectively.
  
  
  CONCLUSIONS
  The TSII can be completed in 5 min, is perceived as easy to complete, and yielded highly acceptable parameters of validity and reliability. Copyright © 2016 John Wiley & Sons, Ltd.
authors: Department of Psychiatry, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan.|School of Medicine, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan.
authors: Shwu-Hua
authors: SH
authors: Lee
authors: School of Nursing, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan.|Department of Nursing, Chang Gung University of Science and Technology, Tao-Yuan, Taiwan.|Department of Psychiatry, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan.
authors: Yun-Fang
authors: YF
authors: Tsai
authors: School of Nursing, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan.
authors: Yi-Wen
authors: YW
authors: Wang
authors: Division of Internal Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan.
authors: Ying-Jen
authors: YJ
authors: Chen
authors: School of Nursing, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan.
authors: Hsiu-Hsin
authors: HH
authors: Tsai
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003866:Depressive Disorder / Q000175:diagnosis; D005163:Factor Analysis, Statistical; D005260:Female; D015577:Geriatric Assessment / Q000379:methods; D006801:Humans; D008132:Loneliness / Q000523:psychology; D008297:Male; D010045:Outpatients; D011320:Primary Health Care; D011594:Psychometrics / Q000379:methods* / Q000592:standards; D012372:ROC Curve; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D059020:Suicidal Ideation; D013624:Taiwan; D000092864:Suicide Prevention
keywords: instrument; older people; reliability; triggers of suicidal ideation; validity