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Prospective Development and Validation of the Computerized Adaptive Screen for Suicidal Youth
Cheryl A King1, David Brent2, Jacqueline Grupp-Phelan3
1Department of Psychiatry, University of Michigan, Ann Arbor.
JAMA Psychiatry
|February 3, 2021
Summary
The Computerized Adaptive Screen for Suicidal Youth (CASSY) effectively identifies at-risk adolescents in emergency departments. This tool shows high accuracy in predicting suicide attempts, aiding timely mental health interventions.
Area of Science:
- Adolescent mental health
- Suicidology
- Emergency medicine
Background:
- Adolescent suicide rates are increasing in the US.
- Many at-risk youth remain unidentified and lack mental health services.
Purpose of the Study:
- To develop and validate the Computerized Adaptive Screen for Suicidal Youth (CASSY).
- To implement CASSY as a universal suicide risk screen in emergency departments (EDs).
Main Methods:
- Prospective enrollment of adolescents (12-17 years) in US EDs across two studies.
- Development of CASSY algorithms using a 3-item anchor and adaptive questioning.
- Independent validation of CASSY in a separate cohort with 3-month follow-up for suicide attempts.
Main Results:
- CASSY algorithms demonstrated excellent predictive accuracy for suicide attempts (AUC 0.89 in Study 1, 0.87 in Study 2).
- At 80% specificity, CASSY achieved 83% sensitivity in Study 1 and 82.4% in Study 2.
- The adaptive screen used an average of 11 items (range 5-21).
Conclusions:
- The adaptive and personalized CASSY shows high accuracy in identifying suicide attempt risk.
- CASSY has the potential to improve the identification of at-risk youth.
- This tool can facilitate timely linkage to essential mental health services.
