Identifying the missing piece of suicide prevention : Formative risk assessment

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.Ph.D

Adolescent Sexual Assault and Suicidal Behaviors : Investigating a National Sample

This study was designed to shed light on two public health concerns: sexual assault and suicidal behaviors among the adolescent population. Sexual assault history, sex differences, and the combination of both sexual assault history and sex were examined when considering suicidal behaviors among high-school adolescents. This study utilized responses from the most recent national survey, 2007 Youth Risk Behavior Surveillance System. Adolescents reporting a history of sexual assault were approximately six times (OR=6.384) more likely to have attempted suicide in the past year when compared to adolescents reporting no history of sexual assault. When examining each sex separately, the relationship was stronger for males: Males reporting a history of sexual assault were nearly ten times (OR=9.757) as likely to have attempted suicide at least once in the past year when compared to males reporting no such history. Females reporting a history of sexual assault were nearly five times (OR=4.712) more likely to have attempted suicide in the previous twelve months when compared to females reporting no such history. When examining suicidal behaviors among adolescents reporting a sexual assault history, the rates between male and female adolescents were indistinguishable. That is, on average, 26% of males and females with a sexual assault history attempted suicide within the past 12 months. In order to investigate the impact on suicide attempts requiring medical attention, the final, iterative logistic regression models included age, sexual assault history, and sex x sexual assault history as an interaction term. A statistically significant sex x sexual assault history emerged, Wald chi-square (1, 40)=11.00, p=.002 when examining responses from adolescents reporting suicidal behavior within the past 12 months. That is, males reporting a sexual assault history reported suicide attempts requiring medical attention more frequently than male suicide attempters without sexual assault histories, as well as both groups of female suicide attempters - both with and without sexual assault histories. Implications for the existing literature base and potential school-based suicide prevention and intervention programs are discussed.  M.A

Identifying the missing piece of suicide prevention : Formative risk assessment

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

Adolescent Sexual Assault and Suicidal Behaviors : Investigating a National Sample

This study was designed to shed light on two public health concerns: sexual assault and suicidal behaviors among the adolescent population. Sexual assault history sex differences and the combination of both sexual assault history and sex were examined when considering suicidal behaviors among high-school adolescents. This study utilized responses from the most recent national survey 2007 Youth Risk Behavior Surveillance System. Adolescents reporting a history of sexual assault were approximately six times (OR=6.384) more likely to have attempted suicide in the past year when compared to adolescents reporting no history of sexual assault. When examining each sex separately the relationship was stronger for males: Males reporting a history of sexual assault were nearly ten times (OR=9.757) as likely to have attempted suicide at least once in the past year when compared to males reporting no such history. Females reporting a history of sexual assault were nearly five times (OR=4.712) more likely to have attempted suicide in the previous twelve months when compared to females reporting no such history. When examining suicidal behaviors among adolescents reporting a sexual assault history the rates between male and female adolescents were indistinguishable. That is on average 26% of males and females with a sexual assault history attempted suicide within the past 12 months. In order to investigate the impact on suicide attempts requiring medical attention the final iterative logistic regression models included age sexual assault history and sex x sexual assault history as an interaction term. A statistically significant sex x sexual assault history emerged Wald chi-square (1 40)=11.00 p=.002 when examining responses from adolescents reporting suicidal behavior within the past 12 months. That is males reporting a sexual assault history reported suicide attempts requiring medical attention more frequently than male suicide attempters without sexual assault histories as well as both groups of female suicide attempters - both with and without sexual assault histories. Implications for the existing literature base and potential school-based suicide prevention and intervention programs are discussed.

Curriculum-based measurement of oral reading (R-CBM): A diagnostic test accuracy meta-analysis of evidence supporting use in universal screening

A great deal of research over the past decade has examined the appropriateness of curriculum-based measurement of oral reading (R-CBM) in universal screening. Multiple researchers have meta-analyzed available correlational evidence, yielding support for the interpretation of R-CBM as an indicator of general reading proficiency. In contrast, researchers have yet to synthesize diagnostic accuracy evidence, which pertains to the defensibility of the use of R-CBM for screening purposes. The overall purpose of this research was to therefore conduct the first meta-analysis of R-CBM diagnostic accuracy research. A systematic search of the literature resulted in the identification of 34 studies, including 20 peer-reviewed articles, 7 dissertations, and 7 technical reports. Bivariate hierarchical linear models yielded generalized estimates of diagnostic accuracy statistics, which predominantly exceeded standards for acceptable universal screener performance. For instance, when predicting criterion outcomes within a school year (≤ 9 months), R-CBM sensitivity ranged between .80 and .83 and specificity ranged between .71 and .73. Multiple moderators of R-CBM diagnostic accuracy were identified, including the (a) R-CBM cut score used to define risk, (b) lag in time between R-CBM and criterion test administration, and (c) percentile rank corresponding to the criterion test cut score through which students were identified as either truly at risk or not at risk. Follow-up analyses revealed substantial variability of extracted cut scores within grade and time of year (i.e., fall, winter, and spring). This result called into question the inflexible application of a single cut score across contexts and suggested the potential necessity of local cut scores. Implications for practices, directions for future research, and limitations are discussed