Indian Journal of PsychiatryIndian Journal of Psychiatry
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Year : 2013  |  Volume : 55  |  Issue : 3  |  Page : 283-286

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

1 Department of Psychiatry and Behavioral Medicine, Wake Forest University School of Medicine, Winston Salem, NC; Department of Psychiatry and Health Behavior, The Medical College of Georgia, Georgia Regents University, Augusta, Georgia, USA
2 Department of Psychiatry, University of Louisville, Louisville, Kentucky, USA
3 Psychiatric Associates of North Carolina, Raleigh, NC, USA
4 Department of Psychiatry and Behavioral Medicine, Wake Forest University School of Medicine, Winston Salem, NC, USA

Correspondence Address:
W Vaughn McCall
Department of Psychiatry and Health Behavior, Georgia Health Sciences University, 997 St. Sebastian Way, Augusta, GA 30909
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Source of Support: NIH award 1 R01 MH095776.01, Conflict of Interest: None

DOI: 10.4103/0019-5545.117150

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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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