Concurrent validity and reliability of suicide risk assessment instruments: a meta analysis of 20 instruments across 27 international cohorts

Adrian I. Campos, Laura S. Van Velzen, Dick J. Veltman, Elena Pozzi, Sonia Ambrogi, Elizabeth D. Ballard, Nerisa Banaj, Zeynep Başgöze, Sophie Bellow, Francesco Benedetti, Irene Bollettini, Katharina Brosch, Erick J. Canales-Rodríguez, Emily K. Clarke-Rubright, Lejla Colic, Colm G. Connolly, Philippe Courtet, Kathryn R. Cullen, Udo Dannlowski, Maria R. DauvermannChristopher G. Davey, Jeremy Deverdun, Katharina Dohm, Tracy Erwin-Grabner, Roberto Goya-Maldonado, Negar Fani, Lydia Fortea, Paola Fuentes-Claramonte, Ali Saffet Gonul, Ian H. Gotlib, Dominik Grotegerd, Mathew A. Harris, Ben J. Harrison, Courtney C. Haswell, Emma L. Hawkins, Dawson Hill, Yoshiyuki Hirano, Tiffany C. Ho, Fabrice Jollant, Tanja Jovanovic, Tilo Kircher, Bonnie Klimes-Dougan, Emmanuelle le Bars, Christine Lochner, Andrew M. McIntosh, Susanne Meinert, Yara Mekawi, Elisa Melloni, Philip Mitchell, Rajendra A, Morey, Akiko Nakagawa, Igor Nenadić, Emilie Olié, Fabricio Pereira, Rachel D. Phillips, Fabrizio Piras, Sara Poletti, Edith Pomarol-Clotet, Joaquim Radua, Kerry J. Ressler, Gloria Roberts, Elena Rodriguez-Cano, Matthew D. Sacchet, Raymond Salvador, Anca-Larisa Sandu, Eiji Shimizu, Aditya Singh, Gianfranco Spalletta, Douglas Steele, Dan J. Stein, Frederike Stein, Jennifer S. Stevens, Giana I. Teresi, Aslihan Uyar-Demir, Nic J. van der Wee, Steven J. van der Werff, Sanne J. H. van Rooij, Daniela Vecchio, Norma Verdolini, Eduard Vieta, Gordon D. Waiter, Heather C. Whalley, Sarah L. Whittle, Tony T. Yang, Carlos A. Zarate Jr., Paul M. Thompson, Neda Jahanshad, Anne-Laura van Harmelen, Hilary P. Blumberg, Lianne Schmaal, Miguel E. Renteria (Lead / Corresponding author)

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Objective: A major limitation of current suicide research is the lack of power to identify robust correlates of suicidal thoughts or behavior. Variation in suicide risk assessment instruments used across cohorts may represent a limitation to pooling data in international consortia. Method: Here, we examine this issue through two approaches: (a) an extensive literature search on the reliability and concurrent validity of the most commonly used instruments and (b) by pooling data (N ∼ 6,000 participants) from cohorts from the Enhancing NeuroImaging Genetics Through Meta-Analysis (ENIGMA) Major Depressive Disorder and ENIGMA–Suicidal Thoughts and Behaviour working groups, to assess the concurrent validity of instruments currently used for assessing suicidal thoughts or behavior. Results: We observed moderate-to-high correlations between measures, consistent with the wide range (κ range: 0.15–0.97; r range: 0.21–0.94) reported in the literature. Two common multi-item instruments, the Columbia Suicide Severity Rating Scale and the Beck Scale for Suicidal Ideation were highly correlated with each other (r = 0.83). Sensitivity analyses identified sources of heterogeneity such as the time frame of the instrument and whether it relies on self-report or a clinical interview. Finally, construct-specific analyses suggest that suicide ideation items from common psychiatric questionnaires are most concordant with the suicide ideation construct of multi-item instruments. Conclusions: Our findings suggest that multi-item instruments provide valuable information on different aspects of suicidal thoughts or behavior but share a modest core factor with single suicidal ideation items. Retrospective, multisite collaborations including distinct instruments should be feasible provided they harmonize across instruments or focus on specific constructs of suicidality.

Original languageEnglish
Pages (from-to)315-329
Number of pages15
Issue number3
Publication statusPublished - Mar 2023


  • suicide
  • concurrent validity
  • harmonisation
  • psychometrics
  • instruments
  • harmonization

ASJC Scopus subject areas

  • Neuropsychology and Physiological Psychology


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