Development and psychometric properties of the Suicidality: Treatment Occurring in Paediatrics (STOP) Suicidality Assessment Scale (STOP-SAS) in children and adolescents

I. Flamarique (Lead / Corresponding author), P. Santosh, A. Zuddas, C. Arango, D. Purper-Ouakil, P. J. Hoekstra, D. Coghill, U. Schulze, R. W. Dittmann, J. K. Buitelaar, K. Lievesley, R. Frongia, C. Llorente, I. Méndez, R. Sala, F. Fiori, J. Castro-Fornieles

    Research output: Contribution to journalArticlepeer-review

    14 Citations (Scopus)
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    Background: To create a self-reported, internet-based questionnaire for the assessment of suicide risk in children and adolescents. 

    Methods: As part of the EU project 'Suicidality: Treatment Occurring in Paediatrics' (STOP project), we developed web-based Patient Reported Outcome Measures (PROMs) for children and adolescents and for proxy reports by parents and clinicians in order to assess suicidality. Based on a literature review, expert panels and focus groups of patients, we developed the items of the STOP Suicidality Assessment Scale (STOP-SAS) in Spanish and English, translated it into four more languages, and optimized it for web-based presentation using the HealthTrackerTM platform. Of the total 19 questions developed for the STOP-SAS, four questions that assess low-level suicidality were identified as screening questions (three of them for use with children, and all four for use with adolescents, parents and clinicians). A total of 395 adolescents, 110 children, 637 parents and 716 clinicians completed the questionnaire using the HealthTrackerTM, allowing us to evaluate the internal consistency and convergent validity of the STOP-SAS with the clinician-rated Columbia Suicide Severity Rating Scale (C-SSRS). Validity was also assessed with the receiver operating characteristic (ROC) area of the STOP-SAS with the C-SSRS. 

    Results: The STOP-SAS comprises 19 items in its adolescent, parent, and clinician versions, and 14 items in its children's version. Good internal consistency was found for adolescents (Cronbach's alpha: 0.965), children (Cronbach's alpha: 0.922), parents (Cronbach's alpha: 0.951) and clinicians (Cronbach's alpha: 0.955) versions. A strong correlation was found between the STOP-SAS and the C-SSRS for adolescents (r:0.670), parents (r:0.548), clinicians (r:0.863) and children (r:0.654). The ROC area was good for clinicians' (0.917), adolescents' (0.834) and parents' (0.756) versions but only fair (0.683) for children's version. 

    Conclusions: The STOP-SAS is a comprehensive, web-based PROM developed on the HealthTrackerTM platform, and co-designed for use by adolescents, children, parents and clinicians. It allows the evaluation of aspects of suicidality and shows good reliability and validity.

    Original languageEnglish
    Article number213
    Pages (from-to)1-13
    Number of pages13
    JournalJAMA Pediatrics
    Issue number1
    Publication statusPublished - 13 Dec 2016


    • Adolescents
    • Adverse events
    • Assessment
    • Children
    • Parents
    • Scale
    • Suicidality

    ASJC Scopus subject areas

    • Pediatrics, Perinatology, and Child Health


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