Applying Computer Adaptive Testing Methods to Suicide Risk Screening in the Emergency Department

Area of Science:

• Psychiatry
• Psychometrics
• Health Informatics

Background:

• Emergency departments (EDs) face challenges in rapidly and accurately assessing suicide risk.
• Existing suicide risk measures can be time-consuming and require specialized training.
• There is a need for brief, reliable, and technology-driven screening tools in acute care settings.

Purpose of the Study:

• To develop and test a computer adaptive test (CAT) for suicide ideation.
• To evaluate the feasibility and accuracy of a CAT for suicide risk screening in the ED population.
• To leverage test theory and technology for efficient suicide risk assessment.

Main Methods:

• A CAT for suicide risk was developed using the Beck Scale for Suicide Ideation (BSS).
• The CAT was administered to 1,350 patients in Massachusetts EDs.
• Data analysis followed the National Institutes of Health Patient-Reported Outcomes Measurement Information System (PROMIS) guidelines.

Main Results:

• Five percent (74/1,350) of patients scored above the BSS cutoff.
• Item 2, "Wish to die," was the most informative item.
• Patient classification was achieved after four items with CAT estimates comparable to the full BSS scale, with minimal misclassification.

Conclusions:

• This study demonstrates the development of a CAT for suicide ideation, a novel screening tool for EDs.
• CATs have the potential to revolutionize behavioral health screening by overcoming time and knowledge barriers.
• Further development of CATs can enhance suicide risk assessment in emergency settings.