Psychometric evaluation of the 9-item Concise Health Risk Tracking-Self-Report (CHRT-SR9) (a measure of suicidal risk) in adolescent psychiatric outpatients in the Texas Youth Depression and Suicide Research Network (TX-YDSRN)

Background: This study evaluated the psychometric properties of the 9-item Concise Health Risk Tracking SelfReport (CHRT-SR9), a measure of suicidality, in adolescent psychiatric outpatients. Methods: Altogether, 933 depressed or suicidal adolescents (12-20 years of age), receiving treatment at psychiatric outpatient clinics in Texas, completed the 16-item CHRT-SR at baseline and one month later. CHRT-SR9 was extracted from CHRT-SR16 using multigroup confirmatory factor analysis. Sex and age measurement invariance, classical test theory, item response theory (IRT), and concurrent validity analyses (against the suicidal ideation Item 9 of Patient Health Questionnaire-Adolescent (PHQ-A)) were conducted.Results: The CHRT-SR9 demonstrated excellent model fit with four factors (pessimism, helplessness, despair, and suicidal thoughts). Measurement invariance was upheld. Acceptable item-total correlations (0.56-0.80) and internal consistency (Spearman-Brown 0.78-0.89) were revealed. IRT analyses showed a unidimensional instrument with excellent item performance. Using the CHRT-SR9 total score as a measure of overall suicidality and comparing it against levels of PHQ-A Item 9, the mean (standard deviation) of CHRT-SR9 total score was 8.64 (SD = 5.97) for no-risk (0 on Item 9), 17.05 (SD = 5.00) for mild, 23.16 (SD = 5.05) for moderate, and 26.96 (SD = 5.24) for severe-risk (3 on Item 9). Significant differences (p-value<0.0001) indicated that CHRT-SR9 total score distinguished between levels of suicidal risk. Furthermore, CHRT-SR9 was sensitive to change over a onemonth period. Limitations: Whether CHRT-SR9 predicts actual suicidal attempts in adolescents is not well defined.Conclusion: The CHRT-SR9 is an easy-to-administer, user-friendly self-report with good psychometric qualities which makes it an excellent screening measure of suicidal risk in adolescent psychiatric outpatients.

Automated summary

This study evaluated the psychometric properties of the 9-item Concise Health Risk Tracking SelfReport (CHRT-SR9) as a measure of suicidality in adolescent psychiatric outpatients. The CHRT-SR9 demonstrated excellent model fit and measurement invariance, with good reliability and validity. The findings suggest that CHRT-SR9 is a useful screening measure of suicidal risk in adolescent psychiatric outpatients. Rating: 8 out of 10.