Identifying the missing piece of suicide prevention : Formative risk assessment

Abstract

Suicide is the third leading cause of death among adolescents and young adults (Centers for Disease Control [CDC], 2011). However, no evidence-based suicide prevention programs currently exist that utilize formative assessment measures to screen for individuals deemed at-risk (National Registry of Evidence-based Programs and Practices [NREPP], n.d.). Given that timely intervention may prevent premature death, there is a dire need to create a direct, formative measure to account for the time-sensitive nature of the data. Glover and Albers (2007) suggest that universal screening measures should be feasible, contextually appropriate, and technically adequate. Borrowing from the literature base of school-based behavior assessment, a widely used, formative measure known as Direct Behavior Rating (DBR; Chafouleas, Riley-Tillman, & McDougal, 2002) was adapted to create a formative suicide risk assessment measure, known as the Direct Behavior Risk Rating (DBRR). The DBRR is a no-cost, 5-item measure that is designed to identify students at-risk for engaging in suicidal activity. The present study tested the hypotheses that DBRRs demonstrate concurrent validity with regard to the Beck Scale for Suicidal Ideation (BSI; Hypothesis 1), demonstrate overall classification accuracy with regard to BSI risk status (Hypothesis 2), and identify cut scores associated with optimal conditional probability statistics (Hypothesis 3). Compared to single DBRR items, the DBRR-Multiple Item Scale (DBRR-MIS) demonstrated a moderate to strong correlation with the BSI and appropriate discriminatory power when modeled against the BSI as the criterion, respectively. Adequate cut scores were identified for the DBRR-MIS for potential differentiation of risk status. However, as the purpose of a screening measurement tool is to achieve an optimal percentage of correct decisions (i.e., true positives & true negatives), results of receiver operating characteristic (ROC) curve analyses indicated that the DBRR-MIS displays a disproportionate balance among probability statistics (i.e., positive predictive power & negative predictive power), resulting in over-identification of those at risk. Given that limited resources often thwart screening implementation in educational settings, further research is needed to improve the technical adequacy of the DBRR. Initial findings indicate that, upon continued examination, the DBRR-MIS may be an innovative method of assessing suicide risk among the student population.