Development and psychometric properties of the Suicidality: Treatment Occurring in Paediatrics (STOP) Suicidality Assessment Scale (STOP-SAS) in children and adolescents

Abstract

BackgroundTo create a self-reported, internet-based questionnaire for the assessment of suicide risk in children and adolescents.MethodsAs part of the EU project ‘Suicidality: Treatment Occurring in Paediatrics’ (STOP project), we developed web-based Patient Reported Outcome Measures (PROMs) for children and adolescents and for proxy reports by parents and clinicians in order to assess suicidality. Based on a literature review, expert panels and focus groups of patients, we developed the items of the STOP Suicidality Assessment Scale (STOP-SAS) in Spanish and English, translated it into four more languages, and optimized it for web-based presentation using the HealthTrackerTM platform. Of the total 19 questions developed for the STOP-SAS, four questions that assess low-level suicidality were identified as screening questions (three of them for use with children, and all four for use with adolescents, parents and clinicians). A total of 395 adolescents, 110 children, 637 parents and 716 clinicians completed the questionnaire using the HealthTrackerTM, allowing us to evaluate the internal consistency and convergent validity of the STOP-SAS with the clinician-rated Columbia Suicide Severity Rating Scale (C-SSRS). Validity was also assessed with the receiver operating characteristic (ROC) area of the STOP-SAS with the C-SSRS.ResultsThe STOP-SAS comprises 19 items in its adolescent, parent, and clinician versions, and 14 items in its children’s version. Good internal consistency was found for adolescents (Cronbach’s alpha: 0.965), children (Cronbach’s alpha: 0.922), parents (Cronbach’s alpha: 0.951) and clinicians (Cronbach’s alpha: 0.955) versions. A strong correlation was found between the STOP-SAS and the C-SSRS for adolescents (r:0.670), parents (r:0.548), clinicians (r:0.863) and children (r:0.654). The ROC area was good for clinicians’ (0.917), adolescents’ (0.834) and parents’ (0.756) versions but only fair (0.683) for children’s version.ConclusionsThe STOP-SAS is a comprehensive, web-based PROM developed on the HealthTrackerTM platform, and co-designed for use by adolescents, children, parents and clinicians. It allows the evaluation of aspects of suicidality and shows good reliability and validity.

Asociación entre la calidad de vida relacionada con la salud y riesgo suicida en adolescentes: estudio transversal

“…Esta capacidad de discriminación fue similar a la escala de Okasha 17 , aunque esta presenta mejores valores de especificidad (79%); y a otras escalas que abordan directamente la suicidalidad; por ejemplo la escala de pesquisa de adolescentes de Columbia 28 , cuya sensibilidad es del 88% y especificidad de 72%; y la escala STOP-SAS 16 con valores similares. El haber incluido el constructo de la CVRS en este estudio, permitió abordar de forma indirecta no solamente la esfera de la salud mental, sino también la valoración de la salud física propiamente tal y la autopercepción del estado de salud de los adolescentes de este estudio.…”

“…Si bien existen cuestionarios específicos para la pesquisa y estratificación de riesgo suicida a nivel comunitario o individual [12][13][14][15][16] , solo la escala de suicidalidad de Okasha esta validada en Chile 17 . Adicionalmente, las escalas de suicidalidad no consideran que el 66% de las víctimas no comunican sus planes o pensamientos suicidas 18 .…”

Self-injurious behavior and related mortality in children under 10 years of age: a retrospective health record study in Brazil

“…3 SB is complex, varies in severity, and encompasses several actions performed by a person that could lead to the person's own death, including suicidal ideation (SI) (thoughts about death and a desire to be dead), suicide plans (thoughts about self-harm that could result in death), communications or threats about suicide (transmitting or expressing thoughts about the explicit or implicit intent of suicide), SA (self-inflicted behavior with the aim of dying with a nonfatal outcome), and suicide. 4,5 Suicide involves a deliberate act of self-directed violence, the outcome of which is death. 6 Suicide is a major cause of death worldwide, with approximately 1 million deaths per year 7 ; it corresponds to more than half of all violent deaths in the world, and is currently the second leading cause of death in the 15-to 29-year-old age group.…”

Development and psychometric properties of the “Suicidality: Treatment Occurring in Paediatrics (STOP) Risk and Resilience Factors Scales” in adolescents

“…Systematic literature review A comprehensive and systematic literature review was performed at the outset of the study to identify the common and frequently reported risk and protective factors for suicidality in the paediatric population [21]. It also considered the aspects of suicidality that were covered by the C-SSRS [20] and other features relating to the revised nomenclature for the study of suicidal behaviours [22].…”