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Predicting Planned Suicide Attempts With the Columbia-Suicide Severity Rating Scale

A Subanalysis of the 2013 Korea National Suicide Survey on Emergency Department Visitors

Park, C. Hyung Keun, MD*†; Kim, Hyeyoung, MD†‡; Kim, Bora, MD, MAS§; Kim, Eun Young, MD, PhD*∥; Lee, Hyun Jeong, MD¶#; Kim, Daewook, MD**; Ahn, Yong Min, MD, PhD*†

The Journal of Nervous and Mental Disease: February 2019 - Volume 207 - Issue 2 - p 59–68
doi: 10.1097/NMD.0000000000000921
Original Articles

Identifying predictors of planned suicide attempts (PSA) is critical because these are associated with grave consequences. Using data of suicide attempters visiting emergency departments, we investigated whether the Columbia-Suicide Severity Rating Scale (C-SSRS) subscales, by retrospectively evaluating ideation before an attempt, could predict the occurrence of PSA versus unplanned suicide attempts using logistic regression analyses. The severity subscale was used as a continuous (model A) and a categorical (model B) variable. In model A, higher scores on each subscale were associated with increased risk of PSA. In model B, the highest score on the severity subscale and a higher intensity subscale score predicted PSA. The severity and intensity subscales had areas under receiver operating curves of 0.712 and 0.688 with optimum cutoff points of 4/5 and 15/16, respectively. In addition, being aged 30 to 49 and 50 to 69 years, being male, interpersonal stress, and depressive and adjustment disorders increased PSA risk. The C-SSRS subscales, along with sociodemographic and clinical risk factors, can predict PSA.

*Department of Neuropsychiatry, Seoul National University Hospital;

Department of Psychiatry and Behavioral Science, Seoul National University College of Medicine, Seoul;

Department of Psychiatry, Inha University Hospital, Incheon, Republic of Korea;

§Department of Psychiatry, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California;

Mental Health Center, Seoul National University Health Care Center, Seoul;

Cancer Survivorship Branch, National Cancer Control Institute;

#Mental Health Clinic, National Cancer Center, Goyang-si, Gyeonggi-do; and

**Department of Psychiatry, Pusan National University Yangsan Hospital, Yangsan-si, Gyeongsangnam-do, Republic of Korea.

Send reprint requests to Yong Min Ahn, MD, PhD, Department of Neuropsychiatry, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea. E-mail:

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