Development and validation of the 9-item Concise Mental Health Checklist (CMHC-9) for suicide risk assessment

Early detection of suicide risk is a challenge in suicide prevention. A comprehensive yet efficient tool providing timely identification of key risk factors allows healthcare providers to initiate interventions. The study aims to validate the 9-item Concise Mental Health Checklist (CMHC-9).

A series of cross-sectional surveys were conducted in 3982 participants from psychiatric outpatient (n = 931), medical outpatient (n = 931) and community (n = 2120) populations. The factor analysis with internal consistency coefficients (Cronbach's α) and receiver operating characteristic (ROC) analysis were performed to evaluate the scale's reliability and validity.

The internal consistency of the CMHC-9 was satisfactory based on Cronbach's α values for the total sample (α = 0.79) and the three sub-samples (i.e., α = 0.76 for psychiatric subjects; 0.67 for community subjects; and 0.69 for medical outpatient subjects). Hierarchical exploratory factor analysis revealed that the CMHC-9 was a single-dimensional scale with two-factor structure of psychopathology and suicidality. The two-factor solution was confirmed by confirmatory factor analysis. The optimal cut-off of 3/4 obtained from the ROC analysis represented a satisfactory sensitivity (92%) and specificity (82%) in identifying recent suicide ideation.

This large-scale study confirmed the CMHC-9 as a brief and effective tool for suicide risk detection. It is recommended that CMHC-9 can be used for care engagement and risk identification in both medical and community settings among people at risk for suicide.