A psychometric cut-point to separate emergently suicidal depressed patients from stable depressed outpatients

W. Vaughn McCall, Nicolas Batson, Megan Webster, Indu Joshi, Todd Derreberry, Adam McDonough, Suzan Farris

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Context: The design of safe clinical trials targeting suicidal ideation requires operational definitions of what degree of suicidal ideation is too excessive to allow safe participation. Aims: We examined the Scale for Suicide Ideation (SSI) to develop a psychometric cut-point that would identify patients having a suicidal emergency. Settings and Design: The Emergency Department (ED) and the out-patient clinic of a university hospital. Materials and Methods: We used the SSI to contrast 23 stable, depressed adult out-patients versus 11 depressed adult ED patients awaiting psychiatric admission for a suicidal emergency. Statistical Analysis: The performance of the SSI was examined with nominal logistic regression. Results: ED patients were older than out-patients (P<0.001), with proportionally more men (P<0.05), and were more ethnically diverse than the outpatients (P<0.005). Compared to out-patients, ED patients were more depressed (Patient Health Questionnaire-9 score 23.1±3.8 vs. 11.7±7.3, P<0.005) and reported a greater degree of suicidal ideation (SSI scores 25.7±7.3 vs. 4.2±8.4, P<0.0001). Nominal logistic regression for the univariate model of SSI score and group yielded a score of 16 (P<0.0001) as the best cut-point in separating groups, with a corresponding Receiver Operating Characteristic Area Under the Curve = 0.94. Of 34 patients in the total sample, only two were misclassified by SSI score = 16, with both of these being false positive for ED status. Thus, the sensitivity of the cut-point was 100% with specificity of 91%. When the model was expanded to include SSI along with age, gender, ethnicity, sedative-hypnotic use, and over-the-counter use, only SSI score remained significant as a predictor. Conclusions: A SSI score ≥16 may be useful as an exclusion criterion for out-patients in depression clinical trials.

Original languageEnglish (US)
Pages (from-to)283-286
Number of pages4
JournalIndian Journal of Psychiatry
Volume55
Issue number3
DOIs
StatePublished - Jul 1 2013

Fingerprint

Psychometrics
Suicide
Outpatients
Hospital Emergency Service
Suicidal Ideation
Emergencies
Logistic Models
Clinical Trials
Hypnotics and Sedatives
ROC Curve
Area Under Curve
Psychiatry
Depression
Health

Keywords

  • Depression
  • emergency department
  • suicidal ideation

ASJC Scopus subject areas

  • Psychiatry and Mental health

Cite this

A psychometric cut-point to separate emergently suicidal depressed patients from stable depressed outpatients. / McCall, W. Vaughn; Batson, Nicolas; Webster, Megan; Joshi, Indu; Derreberry, Todd; McDonough, Adam; Farris, Suzan.

In: Indian Journal of Psychiatry, Vol. 55, No. 3, 01.07.2013, p. 283-286.

Research output: Contribution to journalArticle

McCall, W. Vaughn ; Batson, Nicolas ; Webster, Megan ; Joshi, Indu ; Derreberry, Todd ; McDonough, Adam ; Farris, Suzan. / A psychometric cut-point to separate emergently suicidal depressed patients from stable depressed outpatients. In: Indian Journal of Psychiatry. 2013 ; Vol. 55, No. 3. pp. 283-286.
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abstract = "Context: The design of safe clinical trials targeting suicidal ideation requires operational definitions of what degree of suicidal ideation is too excessive to allow safe participation. Aims: We examined the Scale for Suicide Ideation (SSI) to develop a psychometric cut-point that would identify patients having a suicidal emergency. Settings and Design: The Emergency Department (ED) and the out-patient clinic of a university hospital. Materials and Methods: We used the SSI to contrast 23 stable, depressed adult out-patients versus 11 depressed adult ED patients awaiting psychiatric admission for a suicidal emergency. Statistical Analysis: The performance of the SSI was examined with nominal logistic regression. Results: ED patients were older than out-patients (P<0.001), with proportionally more men (P<0.05), and were more ethnically diverse than the outpatients (P<0.005). Compared to out-patients, ED patients were more depressed (Patient Health Questionnaire-9 score 23.1±3.8 vs. 11.7±7.3, P<0.005) and reported a greater degree of suicidal ideation (SSI scores 25.7±7.3 vs. 4.2±8.4, P<0.0001). Nominal logistic regression for the univariate model of SSI score and group yielded a score of 16 (P<0.0001) as the best cut-point in separating groups, with a corresponding Receiver Operating Characteristic Area Under the Curve = 0.94. Of 34 patients in the total sample, only two were misclassified by SSI score = 16, with both of these being false positive for ED status. Thus, the sensitivity of the cut-point was 100{\%} with specificity of 91{\%}. When the model was expanded to include SSI along with age, gender, ethnicity, sedative-hypnotic use, and over-the-counter use, only SSI score remained significant as a predictor. Conclusions: A SSI score ≥16 may be useful as an exclusion criterion for out-patients in depression clinical trials.",
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