Psychometric Properties of a Persian Version of the Columbia Suicide Severity Rating Scale (C-SSRS) in Iranian Soldiers
-
Amirhossein Jafari
,
AmirMohsen Rahnejat
,
Zahra Hooshyari
,
Arsia Taghva
,
Mohammad Reza Ghasemzadeh
,
Vahid Donyavi
Abstract
Objective: Suicide is an important health issue nearly all over the world. The Columbia Suicide Severity Rating Scale (C-SSRS) is a well-known instrument for suicide risk assessment. Our purpose in this study is to provide a Persian version of the C-SSRS and evaluate its psychometric properties in the Iranian military population, particularly suicide risk leveling characteristic of the C-SSRS.
Method: For linguistic adaptation, we gathered opinions of an expert panel consisting of 23 professionals in mental health sciences. Furthermore, this version was administered to two groups of soldiers, one representing a sample of normal population (N = 338), while the other group comprised a sample of clinical population from a referral psychiatric hospital (N = 348) in Tehran, capital of Iran, from July 2021 until one year later. Besides the C-SSRS, the Beck Scale for Suicidal Ideation (BSSI), Beck Hopelessness Scale (BSS), and General Health Questionnaire 28 (GHQ28) were obtained from the participants. Correlation coefficients, internal consistency, and factor analysis were evaluated using the Statistical Package for the Social Sciences (version 23) software.
Results: All items of the Persian version of the C-SSRS had acceptable content validity and face validity. This tool demonstrated high correlation coefficients with the BSSI (r = 0.73, P < 0.001) and BHS (r = 0.64, P < 0.001), but a low correlation coefficient with the GHQ28 (r = 0.22, P < 0.001). Specifically, the suicide risk level based on the C-SSRS had a high correlation with both the BSSI and BHS. Also, its internal consistency was satisfactory (Cronbach's alpha = 0.89). Furthermore, factor analysis revealed two factors that is consistent with suicidal ideation and suicidal behavior factors.
Conclusion: Our results indicated acceptable validity and reliability for the Persian version of the C-SSRS, demonstrating its capability to classify suicide risk. It can be concluded that the ordinal suicide risk level (as red, orange, yellow and green) is a valid index for the application of the C-SSRS.
1. Organization WH. Suicide worldwide in 2019: global health estimates. 2021.
2. Bakhtar M, Rezaeian M. A survey on the suicidal behavior in Iranian military forces: a systematic review study. JRUMS. 2018;16(11):1065-80.
3. Moradi Y, Dowran B, Sepandi M. The global prevalence of depression, suicide ideation, and attempts in the military forces: a systematic review and Meta-analysis of cross sectional studies. BMC Psychiatry. 2021;21(1):510.
4. Posner K, Subramany R, Amira L, John Mann J. From uniform definitions to prediction of risk: The Columbia suicide severity rating scale approach to suicide risk assessment. Suicide: phenomenology and neurobiology. 2014:59-84.
5. Andreotti ET, Ipuchima JR, Cazella SC, Beria P, Bortoncello CF, Silveira RC, et al. Instruments to assess suicide risk: a systematic review. Trends Psychiatry Psychother. 2020;42(3):276-81.
6. Bjureberg J, Dahlin M, Carlborg A, Edberg H, Haglund A, Runeson B. Columbia-Suicide Severity Rating Scale Screen Version: initial screening for suicide risk in a psychiatric emergency department. Psychol Med. 2021;52(16):1-9.
7. Conway PM, Erlangsen A, Teasdale TW, Jakobsen IS, Larsen KJ. Predictive Validity of the Columbia-Suicide Severity Rating Scale for Short-Term Suicidal Behavior: A Danish Study of Adolescents at a High Risk of Suicide. Arch Suicide Res. 2017;21(3):455-69.
8. Gipson PY, Agarwala P, Opperman KJ, Horwitz A, King CA. Columbia-suicide severity rating scale: predictive validity with adolescent psychiatric emergency patients. Pediatr Emerg Care. 2015;31(2):88-94.
9. Lindh Å U, Waern M, Beckman K, Renberg ES, Dahlin M, Runeson B. Short term risk of non-fatal and fatal suicidal behaviours: the predictive validity of the Columbia-Suicide Severity Rating Scale in a Swedish adult psychiatric population with a recent episode of self-harm. BMC Psychiatry. 2018;18(1):319.
10. Matarazzo BB, Brown GK, Stanley B, Forster JE, Billera M, Currier GW, et al. Predictive Validity of the Columbia-Suicide Severity Rating Scale among a Cohort of At-risk Veterans. Suicide Life Threat Behav. 2019;49(5):1255-65.
11. Posner K, Brown GK, Stanley B, Brent DA, Yershova KV, Oquendo MA, et al. The Columbia-Suicide Severity Rating Scale: initial validity and internal consistency findings from three multisite studies with adolescents and adults. Am J Psychiatry. 2011;168(12):1266-77.
12. Núñez D, Arias V, Méndez-Bustos P, Fresno A. Is a brief self-report version of the Columbia severity scale useful for screening suicidal ideation in Chilean adolescents? Compr Psychiatry. 2019;88:39-48.
13. Pumariega AJ, Good K, Posner K, Millsaps U, Romig B, Stavarski D, et al. Systematic suicide screening in a general hospital setting: process and initial results. World Social Psychiatry. 2020;2(1):31-42.
14. Posner K, Oquendo MA, Gould M, Stanley B, Davies M. Columbia Classification Algorithm of Suicide Assessment (C-CASA): classification of suicidal events in the FDA's pediatric suicidal risk analysis of antidepressants. Am J Psychiatry. 2007;164(7):1035-43.
15. Guidance D. Guidance for Industry Suicidal Ideation and Behavior: Prospective Assessment of Occurrence in Clinical Trials. Clinical/Medical. 2012:1-16.
16. Franks M, Cramer RJ, Cunningham CA, Kaniuka AR, Bryan CJ. Psychometric assessment of two suicide screeners when used under routine conditions in military outpatient treatment programs. Psychol Serv. 2021;18(3):433-9.
17. Peterson K, Anderson J, Bourne D. VA Evidence-based Synthesis Program Reports. Evidence Brief: Suicide Prevention in Veterans. Washington (DC): Department of Veterans Affairs (US); 2018.
18. Park CHK, Kim H, Kim B, Kim EY, Lee HJ, Kim D, et al. Predicting Planned Suicide Attempts With the Columbia-Suicide Severity Rating Scale: A Subanalysis of the 2013 Korea National Suicide Survey on Emergency Department Visitors. J Nerv Ment Dis. 2019;207(2):59-68.
19. Madan A, Frueh BC, Allen JG, Ellis TE, Rufino KA, Oldham JM, et al. Psychometric Reevaluation of the Columbia-Suicide Severity Rating Scale: Findings From a Prospective, Inpatient Cohort of Severely Mentally Ill Adults. J Clin Psychiatry. 2016;77(7):e867-73.
20. Gipson PY, Agarwala P, Opperman KJ, Horwitz A, King CA. Columbia-suicide severity rating scale: predictive validity with adolescent psychiatric emergency patients. Pediatr Emerg Care. 2015;31(2):88-94.
21. Greist JH, Mundt JC, Gwaltney CJ, Jefferson JW, Posner K. Predictive Value of Baseline Electronic Columbia-Suicide Severity Rating Scale (eC-SSRS) Assessments for Identifying Risk of Prospective Reports of Suicidal Behavior During Research Participation. Innov Clin Neurosci. 2014;11(9-10):23-31.
22. Mundt JC, Greist JH, Jefferson JW, Federico M, Mann JJ, Posner K. Prediction of suicidal behavior in clinical research by lifetime suicidal ideation and behavior ascertained by the electronic Columbia-Suicide Severity Rating Scale. J Clin Psychiatry. 2013;74(9):887-93.
23. Viguera AC, Milano N, Laurel R, Thompson NR, Griffith SD, Baldessarini RJ, et al. Comparison of Electronic Screening for Suicidal Risk With the Patient Health Questionnaire Item 9 and the Columbia Suicide Severity Rating Scale in an Outpatient Psychiatric Clinic. Psychosomatics. 2015;56(5):460-9.
24. Goldberg DP, Hillier VF. A scaled version of the General Health Questionnaire. Psychol Med. 1979;9(1):139-45.
25. Beck AT, Weissman A, Lester D, Trexler L. The measurement of pessimism: the hopelessness scale. J Consult Clin Psychol. 1974;42(6):861-5.
26. Beck AT, Steer RA, Ranieri WF. Scale for Suicide Ideation: psychometric properties of a self-report version. J Clin Psychol. 1988;44(4):499-505.
27. Zamanzadeh V, Rassouli M, Abbaszadeh A, Majd HA, Nikanfar A, Ghahramanian A. Details of content validity and objectifying it in instrument development. Nursing Practice Today. 2014;1(3):163-71.
28. Harmer B, Lee S, Duong TVH, Saadabadi A: Suicidal Ideation. In: StatPearls. edn. Treasure Island (FL): StatPearls Publishing Copyright © 2022, StatPearls Publishing LLC.; 2020.
29. Chahine M, Salameh P, Haddad C, Sacre H, Soufia M, Akel M, et al. Suicidal ideation among Lebanese adolescents: scale validation, prevalence and correlates. BMC Psychiatry. 2020;20(1):304.
30. Kilincaslan A, Gunes A, Eskin M, Madan A. Linguistic adaptation and psychometric properties of the Columbia-Suicide Severity Rating Scale among a heterogeneous sample of adolescents in Turkey. Int J Psychiatry Med. 2019;54(2):115-32.
31. Serrani Azcurra D. Psychometric validation of the Columbia-Suicide Severity rating scale in Spanish-speaking adolescents. Colomb Med (Cali). 2017;48(4):174-82.
32. Madan A, Frueh BC, Allen JG, Ellis TE, Rufino KA, Oldham JM, et al. Psychometric Reevaluation of the Columbia-Suicide Severity Rating Scale: Findings From a Prospective, Inpatient Cohort of Severely Mentally Ill Adults. J Clin Psychiatry. 2016;77(7):e867-73.
33. Yershova K, Lesser A, Logan K, Posner K. Asking about suicide as suicide prevention: the Columbia suicide severity rating scale (C-SSRS). Understanding suicide: From diagnosis to personalized treatment. 2016:29-41.
34. Conway PM, Erlangsen A, Teasdale TW, Jakobsen IS, Larsen KJ. Predictive Validity of the Columbia-Suicide Severity Rating Scale for Short-Term Suicidal Behavior: A Danish Study of Adolescents at a High Risk of Suicide. Arch Suicide Res. 2017;21(3):455-69.
35. Shelef L, Klomek AB, Fruchter E, Kedem R, Mann JJ, Zalsman G. Suicide ideation severity is associated with severe suicide attempts in a military setting. Eur Psychiatry. 2019;61:49-55.
36. Lantos T, McNally RJQ, Nyári TA. Patterns of suicide deaths in Hungary between 1995 and 2017. SSM Popul Health. 2021;16:100958.
37. Park SK, Lee CK, Kim H. Suicide mortality and marital status for specific ages, genders, and education levels in South Korea: Using a virtually individualized dataset from national aggregate data. J Affect Disord. 2018;237:87-93.
38. Denney JT, Rogers RG, Krueger PM, Wadsworth T. Adult Suicide Mortality in the United States: Marital Status, Family Size, Socioeconomic Status, and Differences by Sex. Soc Sci Q. 2009;90(5):1167.
39. Pompili M, Vichi M, Qin P, Innamorati M, De Leo D, Girardi P. Does the level of education influence completed suicide? A nationwide register study. J Affect Disord. 2013;147(1-3):437-40.
2. Bakhtar M, Rezaeian M. A survey on the suicidal behavior in Iranian military forces: a systematic review study. JRUMS. 2018;16(11):1065-80.
3. Moradi Y, Dowran B, Sepandi M. The global prevalence of depression, suicide ideation, and attempts in the military forces: a systematic review and Meta-analysis of cross sectional studies. BMC Psychiatry. 2021;21(1):510.
4. Posner K, Subramany R, Amira L, John Mann J. From uniform definitions to prediction of risk: The Columbia suicide severity rating scale approach to suicide risk assessment. Suicide: phenomenology and neurobiology. 2014:59-84.
5. Andreotti ET, Ipuchima JR, Cazella SC, Beria P, Bortoncello CF, Silveira RC, et al. Instruments to assess suicide risk: a systematic review. Trends Psychiatry Psychother. 2020;42(3):276-81.
6. Bjureberg J, Dahlin M, Carlborg A, Edberg H, Haglund A, Runeson B. Columbia-Suicide Severity Rating Scale Screen Version: initial screening for suicide risk in a psychiatric emergency department. Psychol Med. 2021;52(16):1-9.
7. Conway PM, Erlangsen A, Teasdale TW, Jakobsen IS, Larsen KJ. Predictive Validity of the Columbia-Suicide Severity Rating Scale for Short-Term Suicidal Behavior: A Danish Study of Adolescents at a High Risk of Suicide. Arch Suicide Res. 2017;21(3):455-69.
8. Gipson PY, Agarwala P, Opperman KJ, Horwitz A, King CA. Columbia-suicide severity rating scale: predictive validity with adolescent psychiatric emergency patients. Pediatr Emerg Care. 2015;31(2):88-94.
9. Lindh Å U, Waern M, Beckman K, Renberg ES, Dahlin M, Runeson B. Short term risk of non-fatal and fatal suicidal behaviours: the predictive validity of the Columbia-Suicide Severity Rating Scale in a Swedish adult psychiatric population with a recent episode of self-harm. BMC Psychiatry. 2018;18(1):319.
10. Matarazzo BB, Brown GK, Stanley B, Forster JE, Billera M, Currier GW, et al. Predictive Validity of the Columbia-Suicide Severity Rating Scale among a Cohort of At-risk Veterans. Suicide Life Threat Behav. 2019;49(5):1255-65.
11. Posner K, Brown GK, Stanley B, Brent DA, Yershova KV, Oquendo MA, et al. The Columbia-Suicide Severity Rating Scale: initial validity and internal consistency findings from three multisite studies with adolescents and adults. Am J Psychiatry. 2011;168(12):1266-77.
12. Núñez D, Arias V, Méndez-Bustos P, Fresno A. Is a brief self-report version of the Columbia severity scale useful for screening suicidal ideation in Chilean adolescents? Compr Psychiatry. 2019;88:39-48.
13. Pumariega AJ, Good K, Posner K, Millsaps U, Romig B, Stavarski D, et al. Systematic suicide screening in a general hospital setting: process and initial results. World Social Psychiatry. 2020;2(1):31-42.
14. Posner K, Oquendo MA, Gould M, Stanley B, Davies M. Columbia Classification Algorithm of Suicide Assessment (C-CASA): classification of suicidal events in the FDA's pediatric suicidal risk analysis of antidepressants. Am J Psychiatry. 2007;164(7):1035-43.
15. Guidance D. Guidance for Industry Suicidal Ideation and Behavior: Prospective Assessment of Occurrence in Clinical Trials. Clinical/Medical. 2012:1-16.
16. Franks M, Cramer RJ, Cunningham CA, Kaniuka AR, Bryan CJ. Psychometric assessment of two suicide screeners when used under routine conditions in military outpatient treatment programs. Psychol Serv. 2021;18(3):433-9.
17. Peterson K, Anderson J, Bourne D. VA Evidence-based Synthesis Program Reports. Evidence Brief: Suicide Prevention in Veterans. Washington (DC): Department of Veterans Affairs (US); 2018.
18. Park CHK, Kim H, Kim B, Kim EY, Lee HJ, Kim D, et al. Predicting Planned Suicide Attempts With the Columbia-Suicide Severity Rating Scale: A Subanalysis of the 2013 Korea National Suicide Survey on Emergency Department Visitors. J Nerv Ment Dis. 2019;207(2):59-68.
19. Madan A, Frueh BC, Allen JG, Ellis TE, Rufino KA, Oldham JM, et al. Psychometric Reevaluation of the Columbia-Suicide Severity Rating Scale: Findings From a Prospective, Inpatient Cohort of Severely Mentally Ill Adults. J Clin Psychiatry. 2016;77(7):e867-73.
20. Gipson PY, Agarwala P, Opperman KJ, Horwitz A, King CA. Columbia-suicide severity rating scale: predictive validity with adolescent psychiatric emergency patients. Pediatr Emerg Care. 2015;31(2):88-94.
21. Greist JH, Mundt JC, Gwaltney CJ, Jefferson JW, Posner K. Predictive Value of Baseline Electronic Columbia-Suicide Severity Rating Scale (eC-SSRS) Assessments for Identifying Risk of Prospective Reports of Suicidal Behavior During Research Participation. Innov Clin Neurosci. 2014;11(9-10):23-31.
22. Mundt JC, Greist JH, Jefferson JW, Federico M, Mann JJ, Posner K. Prediction of suicidal behavior in clinical research by lifetime suicidal ideation and behavior ascertained by the electronic Columbia-Suicide Severity Rating Scale. J Clin Psychiatry. 2013;74(9):887-93.
23. Viguera AC, Milano N, Laurel R, Thompson NR, Griffith SD, Baldessarini RJ, et al. Comparison of Electronic Screening for Suicidal Risk With the Patient Health Questionnaire Item 9 and the Columbia Suicide Severity Rating Scale in an Outpatient Psychiatric Clinic. Psychosomatics. 2015;56(5):460-9.
24. Goldberg DP, Hillier VF. A scaled version of the General Health Questionnaire. Psychol Med. 1979;9(1):139-45.
25. Beck AT, Weissman A, Lester D, Trexler L. The measurement of pessimism: the hopelessness scale. J Consult Clin Psychol. 1974;42(6):861-5.
26. Beck AT, Steer RA, Ranieri WF. Scale for Suicide Ideation: psychometric properties of a self-report version. J Clin Psychol. 1988;44(4):499-505.
27. Zamanzadeh V, Rassouli M, Abbaszadeh A, Majd HA, Nikanfar A, Ghahramanian A. Details of content validity and objectifying it in instrument development. Nursing Practice Today. 2014;1(3):163-71.
28. Harmer B, Lee S, Duong TVH, Saadabadi A: Suicidal Ideation. In: StatPearls. edn. Treasure Island (FL): StatPearls Publishing Copyright © 2022, StatPearls Publishing LLC.; 2020.
29. Chahine M, Salameh P, Haddad C, Sacre H, Soufia M, Akel M, et al. Suicidal ideation among Lebanese adolescents: scale validation, prevalence and correlates. BMC Psychiatry. 2020;20(1):304.
30. Kilincaslan A, Gunes A, Eskin M, Madan A. Linguistic adaptation and psychometric properties of the Columbia-Suicide Severity Rating Scale among a heterogeneous sample of adolescents in Turkey. Int J Psychiatry Med. 2019;54(2):115-32.
31. Serrani Azcurra D. Psychometric validation of the Columbia-Suicide Severity rating scale in Spanish-speaking adolescents. Colomb Med (Cali). 2017;48(4):174-82.
32. Madan A, Frueh BC, Allen JG, Ellis TE, Rufino KA, Oldham JM, et al. Psychometric Reevaluation of the Columbia-Suicide Severity Rating Scale: Findings From a Prospective, Inpatient Cohort of Severely Mentally Ill Adults. J Clin Psychiatry. 2016;77(7):e867-73.
33. Yershova K, Lesser A, Logan K, Posner K. Asking about suicide as suicide prevention: the Columbia suicide severity rating scale (C-SSRS). Understanding suicide: From diagnosis to personalized treatment. 2016:29-41.
34. Conway PM, Erlangsen A, Teasdale TW, Jakobsen IS, Larsen KJ. Predictive Validity of the Columbia-Suicide Severity Rating Scale for Short-Term Suicidal Behavior: A Danish Study of Adolescents at a High Risk of Suicide. Arch Suicide Res. 2017;21(3):455-69.
35. Shelef L, Klomek AB, Fruchter E, Kedem R, Mann JJ, Zalsman G. Suicide ideation severity is associated with severe suicide attempts in a military setting. Eur Psychiatry. 2019;61:49-55.
36. Lantos T, McNally RJQ, Nyári TA. Patterns of suicide deaths in Hungary between 1995 and 2017. SSM Popul Health. 2021;16:100958.
37. Park SK, Lee CK, Kim H. Suicide mortality and marital status for specific ages, genders, and education levels in South Korea: Using a virtually individualized dataset from national aggregate data. J Affect Disord. 2018;237:87-93.
38. Denney JT, Rogers RG, Krueger PM, Wadsworth T. Adult Suicide Mortality in the United States: Marital Status, Family Size, Socioeconomic Status, and Differences by Sex. Soc Sci Q. 2009;90(5):1167.
39. Pompili M, Vichi M, Qin P, Innamorati M, De Leo D, Girardi P. Does the level of education influence completed suicide? A nationwide register study. J Affect Disord. 2013;147(1-3):437-40.
| Files | ||
| Issue | Vol 19 No 3 (2024) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijps.v19i3.15831 | |
| Keywords | ||
| Psychometrics Reproducibility of Results Suicidal Ideation Suicide Suicide Prevention | ||
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How to Cite
1.
Jafari A, Rahnejat A, Hooshyari Z, Taghva A, Ghasemzadeh MR, Donyavi V. Psychometric Properties of a Persian Version of the Columbia Suicide Severity Rating Scale (C-SSRS) in Iranian Soldiers. Iran J Psychiatry. 2024;19(3):295-305.
