Dual Assessment of Suicidal Risk: Integrating the Clinician-Administered CHRT-Beh and Self-Report CHRT-SR9: Findings From the T-RAD Study

Karabi Nandy,1,2 Lynnel C Goodman,1 Taryn L Mayes,1,3 Emine Rabia Ayvaci,1,4 Joseph M Trombello,1 Joshua S Elmore,1 Srividya Vasu,1 Graham J Emslie,1,4 Madhukar H Trivedi1 1Center for Depression Research and Clinical Care, Peter O’Donnell Jr. Brain Institute and Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA; 2Peter O’Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USA; 3Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA; 4Children’s Health, Children’s Medical Center, Dallas, TX, USACorrespondence: Madhukar H Trivedi, Center for Depression Research and Clinical Care, Peter O’Donnell Jr. Brain Institute, Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390-9119, USA, Tel +214 648 0188, Fax +214 648 0167, Email [email protected]: Suicide prevention requires reliable assessment tools, integrating the Food and Drug Administration (FDA)-endorsed Columbia Classification Algorithm of Suicide Assessment domains and psychological risk factors, capturing patient-reported experiences and clinician-reported characterizations of suicidality comprehensively. The 9-item Concise Health Risk Tracking – Self-Report (CHRT-SR9) is a patient-reported outcome that was designed to capture suicide-related constructs such as pessimism, helplessness, despair, and suicidal thinking/planning. The semi-structured, clinician-administered CHRT-Behavior (CHRT-Beh) scale was created to capture recent suicidal events (ideation and behaviors) in alignment with the FDA-endorsed system for coding suicidality. In this report, we present a two-step approach for assessing suicidality and provide preliminary data for the dual use of the CHRT-SR9 and CHRT-Beh.Methods: Data from the Texas Resilience Against Depression (T-RAD) cohort were used for the analysis. T-RAD consists of two datasets, one with participants with a history of depression and healthy controls (D2K, n=1040, ages 10 and above) and one with youth ages 10– 24 years at risk for depression (RAD, n=365). Participants completed both the CHRT-SR9 and CHRT-Beh at study entry.Results: Using the CHRT-Beh, a subset of D2K participants aged ≥ 24 years reported suicidal ideation (14.07%), non-suicidal self-injury (1.11%), and self-injurious behavior (0.28%) in the past week. Findings were similar in D2K participants aged 10– 24 years. A subset of RAD participants (1.64%) reported suicidal ideation without attempt or self-injurious behavior in the past week. Participants who reported suicidal ideation on the CHRT-Beh had significantly higher CHRT-SR9 total scores (17.1 ± 7.4 vs 5.6 ± 6.2; p< 0.0001) and CHRT-SR9 suicidal ideation subscale scores (4.0 ± 3.1 vs 0.6 ± 1.7; p< 0.0001) than those without suicidal ideation.Conclusion: The co-administration of CHRT-SR9 and CHRT-Beh provides researchers with a suicidality risk measure and a retrospective assessment of suicidal behaviors. The CHRT-SR9 and CHRT-Beh package provides a holistic clinical evaluation of suicidal risk meeting regulatory requirements.Keywords: concise health risk tracking – self report, concise health risk tracking – behavior, Columbia classification algorithm for suicide assessment, Columbia suicide severity rating scale