Use of the Columbia‐Suicide Severity Rating Scale (C‐<scp>SSRS</scp>) in a large sample of Veterans receiving mental health services in the Veterans Health Administration

Katz, Ira R.; Barry, Catherine N.; Cooper, Samantha A.; Kasprow, Wesley J.; Hoff, Rani A.

doi:10.1111/sltb.12584

Cited by 37 publications

(17 citation statements)

References 15 publications

(11 reference statements)

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“…All items are answered with “yes” or “no.” A positive C-SSRS screen was defined as a “yes” response to items 3, 4, 5, or 6b. Previous studies have demonstrated the reliability and validity of the original and screen versions of the C-SSRS [ 5 , 13 ].…”

Section: Methodsmentioning

confidence: 99%

Mental health follow-up and treatment engagement following suicide risk screening in the Veterans Health Administration

et al. 2022

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Importance Understanding the extent to which population-level suicide risk screening facilities follow-up and engagement in mental health treatment is important as engaging at-risk individuals in treatment is critical to reducing suicidal behaviors. Objective To evaluate mental health follow-up and treatment engagement in the Veterans Health Administration (VHA) following administration of the Columbia-Suicide Severity Rating Scale (C-SSRS) screen, a component of the VHA’s universal suicide risk screening program. Design This cross-sectional study used data from VA’s Corporate Data Warehouse. Settings 140 VHA Medical Centers. Participants Patients who completed the C-SSRS screen in ambulatory care between October 1, 2018—September 30, 2020. Exposure Standardized suicide risk screening. Main outcomes and measures Mental health follow-up (one or more visits within 30 days of C-SSRS screening) and treatment engagement (two or more visits within 90 days of C-SSRS screening) were examined. Results 97,224 Veterans in Fiscal Year 2019 (FY19) (mean age 51.4 years; 86.8% male; 64.8% white, 22.4% African-American) and 58,693 Veterans in FY20 (mean age 49.6 years; 85.5% male; 63.4% white, 21.9% African-American) received the C-SSRS screen. Across FYs, a positive C-SSRS screen was associated with increased probability of mental health follow-up and treatment engagement. Patients who were not seen in mental health in the year prior to screening had the greatest increase in probability of mental health follow-up and engagement following a positive screen (P<0.001). For FY19, a positive C-SSRS screen in non-mental health connected patients was associated with an increased probability of follow-up from 49.8% to 79.5% (relative risk = 1.60) and engagement from 39.5% to 63.6% (relative risk = 1.61). For mental health-connected patients, a positive C-SSRS screen was associated with a smaller increase in probability of follow-up from 75.8% to 87.6% (relative risk = 1.16) and engagement from 63.3% to 76.4% (relative risk = 1.21). Results for FY20 were similar. Conclusions and relevance Identification of suicide risk through population-level screening was associated with increased mental health follow-up and engagement, particularly for non-mental health connected patients. Findings support the use of a standardized, comprehensive suicide risk screening program for managing elevated suicide risk in a large healthcare system.

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Section: Methodsmentioning

confidence: 99%

Mental health follow-up and treatment engagement following suicide risk screening in the Veterans Health Administration

et al. 2022

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“…The FDA supported the use of the C-SSRS for suicide risk surveillance tool in clinical trials (Center for Drug Evaluation and Research, 2012). Although the Veteran Health Administration screens for suicide risk with a single item from the PHQ-9 (Kroenke et al, 2001), positive screens are further assessed with the C-SSRS (Katz et al, 2020). However, critics suggest the C-SSRS may lead to overendorsement of suicidal ideation (Giddens et al, 2014), and the semi-structured interview adds significant burden when compared to a self-report measure.…”

Section: Lacking a Gold-standard Assessment For Researchmentioning

confidence: 99%

“…Part of the difficulty in optimizing suicidal ideation assessment is because suicide is a low-probability behavior in high-risk groups, a property that is exacerbated when examining the general population. Therefore, only a few measures (including the BSSI, BHS, and C-SSRS) have predictive validity through associations with future suicide attempts and deaths (Brown, 2002;Katz et al, 2020;Lindh et al, 2019). Although many suicide assessment measures are highly correlated, others have small and negligible correlations (Gutierrez et al, 2019), either indicating the measures have either poor validity or poor coverage of suicide risk factors.…”

Section: Lacking a Gold-standard Assessment For Researchmentioning

confidence: 99%

Examining suicide assessment measures for research use: Using item response theory to optimize psychometric assessment for research on suicidal ideation in major depressive disorder

McCall

Porter

Pate

et al. 2021

Suicide & Life Threat Behav

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Introduction: Progress reducing suicide death will require randomized clinical trials (RCTs) specifically targeting suicide risk. Even large RCTs may not stipulate suicide death as the primary outcome, as suicide death is relatively uncommon. Therefore, RCTs may need to specify suicidal ideation as a proxy indicator of risk. There is no consensus on the best tool for measuring suicidal ideation within RCTs. We contrasted the psychometric performance of three suicidal ideation measures to address this need. Methods: We applied item response theory to the Beck Scale for Suicide Ideation (BSSI), the Columbia-Suicide Severity Rating Scale (C-SSRS), and the suicide item of the Hamilton Rating Scale for Depression (HRSD) for 101 outpatients with depression and suicidal ideation participating in a RCT with suicidal ideation as the primary outcome. Results: All measures of suicidal ideation were equally able to detect low and very high levels of suicidal ideation. Conclusions: The choice of the specific measure of suicidal ideation in a clinical trial may be dictated by time and financial resources versus the need for granularity in the interpretation of the scores.

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“…For the purposes of the current study, the following measures from the C-SSRS were included in analyses: (a) presence or absence of any prior suicide attempt (including interrupted, aborted, and actual suicide attempts), (b) total frequency of prior suicide attempts; (c) presence or absence of any prior suicidal ideation, and (d) most severe prior suicidal ideation, rated on a scale of 1 ( passive wish to be dead ) to 5 ( active suicidal ideation with intent and plan ). Prior research suggests the C-SSRS demonstrates good concurrent and predictive validity in veteran samples (Katz, Barry, Cooper, Kasprow, & Hoff, 2020; Matarazzo et al, 2019).…”

Section: Methodsmentioning

confidence: 99%

Arrest history and psychopathology among veterans at risk for suicide.

Edwards

Gromatsky

Sissoko

et al. 2022

Psychological Services

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While preliminary evidence suggests an association between legal involvement and suicide risk among veterans, no research to date has explored the prevalence and/or correlates of legal involvement among veterans at high risk for suicide. The current study examined the relation of suicide attempt, suicidal ideation, and psychopathology to history of criminal arrest in a sample of 286 veterans at risk for suicide. Results indicated approximately half (47%) of at-risk veterans had a history of arrest. Inconsistent with hypotheses, arrest history was not associated with history of suicide attempt, current suicidal ideation, or severity of psychopathological symptoms. Arrest history was, however, associated with diagnoses of substance use disorder and antisocial personality disorder in this high-suicide risk sample. Further, likelihood of an antisocial personality disorder diagnosis was associated with higher frequency of past arrests. Taken together, results indicate that many veterans at risk for suicide have a history of arrest, and at-risk veterans with such history likely have a specific pattern of psychopathology, including antisocial personality traits and substance use. As such, legal status and history of justice involvement may be important considerations when assessing suicide risk and management of this high-risk population.

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Use of the Columbia‐Suicide Severity Rating Scale (C‐SSRS) in a large sample of Veterans receiving mental health services in the Veterans Health Administration

Cited by 37 publications

References 15 publications

Mental health follow-up and treatment engagement following suicide risk screening in the Veterans Health Administration

Mental health follow-up and treatment engagement following suicide risk screening in the Veterans Health Administration

Examining suicide assessment measures for research use: Using item response theory to optimize psychometric assessment for research on suicidal ideation in major depressive disorder

Arrest history and psychopathology among veterans at risk for suicide.

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