Getting the Best Return on Your Screening Investment: An Analysis of the Suicidal Ideation Questionnaire and Reynolds Adolescent Depression Scale

By Gutierrez, Peter M.; Osman, Augustine | School Psychology Review, June 2009 | Go to article overview

Getting the Best Return on Your Screening Investment: An Analysis of the Suicidal Ideation Questionnaire and Reynolds Adolescent Depression Scale


Gutierrez, Peter M., Osman, Augustine, School Psychology Review


Abstract. Data from 64 adolescent inpatients admitted for serious suicidal ideation, 50 adolescent inpatients admitted following a suicide attempt, and 56 randomly selected high school control participants were used to evaluate the sensitivity, specificity, positive predictive value, and negative predictive value of the Suicidal Ideation Questionnaire (SIQ) and the Reynolds Adolescent Depression Scale--2nd Edition (RADS-2). The purpose of the study was to provide information necessary for selecting assessment tools to use in large-scale screenings of high school students for suicide risk. The hypothesis that a combination of mean scores on the two measures and critical item scores would provide the best clinical utility was partially supported. The SIQ was found to be very useful in discriminating between the study groups, whereas the RADS--2 did not perform as expected. The fewest false negatives would result from relying on RADS-2 scale scores [greater than or equal to]63 and SIQ scale scores [greater than or equal to]4. However, the parsimonious and hence most cost-effective approach would be to rely on SIQ scale scores [greater than or equal to]l4 in combination with SIQ critical Items 2, 3, and 4 for screening purposes.

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Systematic screening to identify adolescents at risk is an important component of secondary suicide prevention efforts (e.g.. Garland, Shaffer, & Whittle, 1989; Miller & DuPaul, 1996; Shaffer, Garland, Vieland, Underwood, & Busner, 1991; Shaffer et al.. 2004); it is a task to which school psychologists are well suited. When conducting such screenings, it is important to assess students for a range of suicide-related risk behaviors (e.g., depressive symptoms and thoughts about suicide (Perez, 2005). A dilemma for schools is that suicide is a low-base-rate behavior (Kung, Hoyert, Xu, & Murphy, 2008) and large-scale screenings can be quite costly. However, 14.5% of adolescents in a national survey reported seriously considering suicide and 11.3% had made a suicide plan in the prior year (Eaton et al., 2008). Adolescents are clearly reporting risk for suicide, and the costs of adolescent suicide in terms of emotional impact on the school, family, and friends are enormous (Gutierrez & Osman, 2008). As a result, suicide risk screenings seem to be a highly defensible investment of school resources. The challenge is determining how to get the best return on that investment.

Several options exist for assessing potentially high-risk adolescents; two of the most widely disseminated are the Columbia Teen-Screen (Columbia University TeenScreen Program, 2007) and the Signs of Suicide (Aseltine & DeMartino, 2004) program. Both have been evaluated by the Substance Abuse and Mental Health Services Administration and are listed in their National Registry of Evidence-based Programs and Practices (Substance Abuse and Mental Health Services Administration, 2006, 2007). A major advantage of these programs is that they are standardized and come with significant amounts of supporting materials. However, there are costs associated with both.

TeenScreen requires supplies (which include laptop computers), postage, and three staff members to administer the program (Substance Abuse and Mental Health Services Administration, 2007). Free consultation, training, and technical assistance are available from the program administrators. Signs of Suicide kits, which include a manual and training video for staff, must be purchased (Substance Abuse and Mental Health Services Administration, 2006). The program also offers in-person training, although it indicates that costs vary depending on the needs of the school. In addition to the financial costs of these programs, which will exist to some extent regardless of the screening method that a school chooses to use, there is currently an absence of published data on the predictive validity (i.e., association between screening results and suicide-related target behaviors) of either program. …

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