Validation of a Computerized Adaptive Test Suicide Scale (CAT-SS) among United States Military Veterans

Brenner, Lisa A.; Betthauser, Lisa M.; Penzenik, Molly; Bahraini, Nazanin H.; Gibbons, Robert D.

doi:10.1371/journal.pone.0261920

Cited by 10 publications

(8 citation statements)

References 14 publications

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“…27 The Computerized Adaptive Test Suicide Scale (CAT-SS) 27 has recently been demonstrated to be feasible in a group-level intervention (n = 1485) in the US Air Force Wingman Connect Study 28 and validated in a population of US veterans. 29 In the Veterans Affairs study, the baseline suicide attempt rate over the past 3 months was 6%. To detect a 50% reduction in suicide attempt rate with power of 0.8 (6% vs 4%) would require 4000 participants.…”

Section: Discussionmentioning

confidence: 99%

“…That study could be conducted in a high-risk population, which would maximize the number of suicidal events, and could also use longitudinal assessments of suicidal events using previously validated adaptive tests for suicidality . The Computerized Adaptive Test Suicide Scale (CAT-SS) has recently been demonstrated to be feasible in a group-level intervention (n = 1485) in the US Air Force Wingman Connect Study and validated in a population of US veterans . In the Veterans Affairs study, the baseline suicide attempt rate over the past 3 months was 6%.…”

Section: Discussionmentioning

confidence: 99%

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Association Between Folic Acid Prescription Fills and Suicide Attempts and Intentional Self-harm Among Privately Insured US Adults

et al. 2022

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ImportanceSuicide is a leading cause of death in the United States, having increased more than 30% from 2000 to 2018. An inexpensive, safe, widely available treatment for preventing suicidal behavior could reverse this trend.ObjectiveTo confirm a previous signal for decreased risk of suicide attempt following prescription fills for folic acid in a national pharmacoepidemiologic study of patients treated with folic acid.Design, Setting, and ParticipantsA within-person exposure-only cohort design was used to study the dynamic association between folic acid (vitamin B9) prescription fills over a 24-month period and suicide attempts and intentional self-harm. Data were collected from a pharmacoepidemiologic database of US medical claims (MarketScan) for patients with private health insurance who filled a folic acid prescription between 2012 and 2017. The same analysis was repeated with a control supplement (cyanocobalamin, vitamin B12). Data were analyzed from August 2021 to June 2022.ExposureFolic acid prescription fills.Main Outcome and MeasureSuicide attempt or intentional self-harm resulting in an outpatient visit or inpatient admission as identified by codes from the International Statistical Classification of Diseases, Ninth and Tenth Revisions, Clinical Modification.ResultsData on 866 586 patients were collected; 704 514 (81.30%) were female, and 90 296 (10.42%) were 60 years and older. Overall, there were 261 suicidal events during months covered by a folic acid prescription (5 521 597 person-months) for a rate of 4.73 per 100 000 person-months, compared with 895 suicidal events during months without folic acid (8 432 340) for a rate of 10.61 per 100 000 person-months. Adjusting for age and sex, diagnoses related to suicidal behavior, diagnoses related to folic acid deficiency, folate-reducing medications, history of folate-reducing medications, and history of suicidal events, the hazard ratio (HR) for folic acid for suicide events was 0.56 (95% CI, 0.48-0.65), with similar results for the modal dosage of 1 mg of folic acid per day (HR, 0.57; 95% CI, 0.48-0.69) and women of childbearing age (HR, 0.60; 95% CI, 0.50-0.73). A duration-response analysis (1-mg dosage) revealed a 5% decrease in suicidal events per month of additional treatment (HR, 0.95; 95% CI, 0.93-0.97). The same analysis for the negative control, cyanocobalamin, found no association with suicide attempt (HR, 1.01; 95% CI, 0.80-1.27).Conclusions and RelevanceThis large-scale pharmacoepidemiologic study of folic acid found a beneficial association in terms of lower rates of suicide attempts. The results warrant the conduct of a randomized clinical trial with suicidal ideation and behavior as outcomes of interest. If confirmed, folic acid may be a safe, inexpensive, and widely available treatment for suicidal ideation and behavior.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Association Between Folic Acid Prescription Fills and Suicide Attempts and Intentional Self-harm Among Privately Insured US Adults

et al. 2022

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“…15 Youth in the Study One Derivation Cohort did not complete the actual CASSY but had the CASSY algorithms applied to their responses to the complete set of 72 CASSY items. CASSY risk threshold levels were informed by previous computerized adaptive tests for suicidal behavior in youth and young adults nationally, 20,21 and in consultation with ED-STARS co-investigators.…”

Section: Methodsmentioning

confidence: 99%

Management of suicidal risk in the emergency department: A clinical pathway using the computerized adaptive screen for suicidal youth

Grupp‐Phelan,

Horwitz,

Brent

et al. 2024

JACEP Open

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ObjectiveGiven the critical need for efficient and tailored suicide screening for youth presenting in the emergency department (ED), this study establishes validated screening score thresholds for the Computerized Adaptive Screen for Suicidal Youth (CASSY) and presents an example of a suicide risk classification pathway.MethodsParticipants were primarily from the Study One derivation cohort of the Emergency Department Screen for Teens at Risk for Suicide (ED‐STARS) enrolled in collaboration with Pediatric Emergency Care Applied Research Networks (PECARN). CASSY scores corresponded to the predicted probabilities of a suicide attempt in the next 3 months and risk thresholds were classified as minimal (<1%), low (1%–5%), moderate (5%–10%), and high (>10%). CASSY scores were compared to risk thresholds derived from clinical consensus and ED complaints and dispositions. CASSY risk thresholds were also examined as predictors of future suicide attempts in the Study Two validation cohort of ED‐STARS.ResultsA total of 1452 teens were enrolled with a median age of 15.2 years, 59.5% were female, 55.6% were White, 22% were Black, 22.3% were Latinx, and 42.8% received public assistance. The clinical consensus suicide risk groups were strongly associated with the CASSY‐predicted risk thresholds. Suicide attempts in the Study Two cohort occurred at a frequency consistent with the CASSY‐predicted thresholds.ConclusionsThe CASSY can be a valuable tool in providing patient‐specific risk probabilities for a suicide attempt at 3 months and tailor the threshold cutoffs based on the availability of local mental health resources. We give an example of a clinical risk pathway, which should include segmentation of the ED population by medical versus psychiatric chief complaint.

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“…The CAT‐SUD also determines frequency of use of alcohol, sedatives/hypnotics, opioid analgesics, heroin/methadone, and cocaine/amphetamines. The CAT‐SS has been prospectively validated in terms of its ability to predict future suicidal behavior 28–30 . Approximately 10 items are administered for the suicide subscale, 12 for depression, 12 for anxiety, 6 for PTSD, and 11 for substance use.…”

Section: Methodsmentioning

confidence: 99%

“…The CAT-SS has been prospectively validated in terms of its ability to predict future suicidal behavior. [28][29][30] Approximately 10 items are administered for the suicide subscale, 12 for depression, 12 for anxiety, 6 for PTSD, and 11 for substance use.…”

Section: Computer Adaptive Testing With the Cat-mhmentioning

confidence: 99%

Computer adaptive testing to assess impairing behavioral health problems in emergency department patients with somatic complaints

et al. 2022

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Objectives To assess: (1) the prevalence of mental health and substance use in patients presenting to the emergency department (ED) through use of a computer adaptive test (CAT‐MH), (2) the correlation among CAT‐MH scores and self‐ and clinician‐reported assessments, and (3) the association between CAT‐MH scores and ED utilization in the year prior and 30 days after enrollment. Methods This was a single‐center observational study of adult patients presenting to the ED for somatic complaints (97%) from May 2019 to March 2020. The main outcomes were computer‐adaptive‐assessed domains of suicidality, depression, anxiety, post‐traumatic stress disorder (PTSD), and substance use. We conducted Pearson correlations and logistic regression for objectives 2 and 3, respectively. Results From a sample of 794 patients, the proportion of those at moderate/severe risk was: 24.1% (suicidality), 8.3% (depression), 16.5% (anxiety), 12.3% (PTSD), and 20.4% (substance use). CAT‐MH domains were highly correlated with self‐report assessments (r = 0.49–0.79). Individuals who had 2 or more ED visits in the prior year had 62% increased odds of being in the intermediate‐high suicide risk category (odds ratio [OR], 1.62; 95% confidence interval [CI], 1.07–2.44) compared to those with zero prior ED visits. Individuals who scored in the intermediate‐high‐suicide risk group had 63% greater odds of an ED visit within 30 days after enrollment compared to those who scored as low risk (OR, 1.63; 95% CI, 1.09, 2.44). Conclusion The CAT‐MH documented that a considerable proportion of ED patients presenting for somatic problems had mental health conditions, even if mild. Mental health problems were also associated with ED utilization.

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Validation of a Computerized Adaptive Test Suicide Scale (CAT-SS) among United States Military Veterans

Cited by 10 publications

References 14 publications

Association Between Folic Acid Prescription Fills and Suicide Attempts and Intentional Self-harm Among Privately Insured US Adults

Association Between Folic Acid Prescription Fills and Suicide Attempts and Intentional Self-harm Among Privately Insured US Adults

Management of suicidal risk in the emergency department: A clinical pathway using the computerized adaptive screen for suicidal youth

Computer adaptive testing to assess impairing behavioral health problems in emergency department patients with somatic complaints

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