Computer Adaptive Testing Can Predict Changes in Suicide Risk Among SGM Youth
Computer adaptive testing can be used to predict the risk of transitioning from suicidal thoughts to suicide attempts for sexual and gender minority (SGM) youth, according to a new study by Institute for Sexual and Gender Minority Health and Wellbeing (ISGMH) researchers.
ISGMH faculty member Johnny Berona, Ph.D., is the lead author of the paper published in Psychiatry Services. “Predicting the Transition from Suicidal Ideation to Suicide Attempt among Sexual and Gender Minority Youths” details the results of a study using the Computer Adaptive Test – Suicide Scale (CAT-SS) as a measure of suicide risk in a sample of over 1,000 SGM young people.
Berona said their research was done out of necessity, citing a lack of studies on the mental health trajectories of SGM youth and the absence of well-established interventions for this population, despite long-standing disparities.
“One of the greatest challenges in the field of suicide prevention is accurately predicting when thoughts of suicide will lead to suicidal behavior. With more personalized assessment tools, we are finally moving the needle on characterizing and predicting changes in suicide risk, and that hopefully moves us closer to preventing suicide in SGM populations,” said Berona.
The study found that CATS-SS scores predicted future suicide attempts in SGM youth above and beyond other factors such as depressed mood, heavy alcohol use, victimization, and social support.
“We first examined the performance of the CAT-SS for all youth in the study. Another focus was more specifically on whether we could detect continued risk among youth who had already considered about suicide—how likely is it that there will be a transition from current suicidal thoughts to a future suicide attempt? It’s one of the most urgent questions clinicians face, and one of the most difficult to answer. So, this study is the first step towards addressing those needs,” said Berona.
Researchers also discovered different predictive factors for youth with and without a history of suicidal ideation (SI). Among youth without a history of SI, social support reduced the risk of attempts. Among youths with a history of SI, predictors of transition included CAT-SS score and reported experience of victimization related to being gay, lesbian, bisexual, or transgender.
In addition to its accuracy, computer adaptive testing offers several distinct advantages over standard methods. Unlike structured interviews, CAT is fully self-report. As a result, it is not subject to clinical bias and does not require the presence of trained staff to be administered.
Berona also highlighted the flexibility CAT offers:
“The CAT-SS was developed from an initial pool of over 1,000 questions that assess multiple aspects of mental health and vary in how directly they relate to suicide. That range is important because someone might not be thinking about suicide at the time they complete the CAT-SS, but they might have other indicators that tell us about how hopeless, lonely, or isolated they feel. Those factors can have profound effects on suicidality but aren’t explicitly incorporated into most risk assessment instruments. Towards accessibility, the CAT-SS is available in multiple languages, has built-in audio aids, and can be completed on any device with internet access.”
With the promising findings of this initial study, the research team is eager to begin use of the CAT-SS in other contexts to measure performance in clinical settings and to determine whether other factors such as age or geographic location affect the results. Berona said they are optimistic implementing the CAT-SS in new locations will facilitate long-term monitoring, allowing administrators to identify high-risk individuals and connect them with intervention more quickly.
“Staff at hospitals, clinics, and community centers who treat SGM youth all want to know when interventions are effective and when more supports need to be added. For our study, looking at whether this can help understand progress over time is going to be an important next step.”
“Predicting the Transition from Suicidal Ideation to Suicide Attempt among Sexual and Gender Minority Youth” was authored by Johnny Berona Ph.D., Sarah W. Whitton, Ph.D., Michael E. Newcomb, Ph.D., Brian Mustanski, Ph.D., and Robert D. Gibbons, Ph.D.
National Suicide Prevention Lifeline: 800-273-8255
The Trevor Project 24/7 Support Services: https://www.thetrevorproject.org/get-help/