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Concise Health Risk Tracking Scale: A Brief Self-Report and Clinician Rating of Suicidal Risk

J Clin Psychiatry 2011;72(6):757-764

Objective: Monitoring suicidality and risk following initiation of antidepressant treatment is an essential component of clinical care, but few brief, reliable ratings of suicidal ideation and behavior in adults are available. This report evaluates the psychometric properties of a brief self- and clinician-rated measure of factors related to the risk of suicide attempt or completion.

Method: Adult outpatients with nonpsychotic major depressive disorder (MDD) (n = 240) were enrolled from July 2007 through February 2008 and treated in an 8-week, open-label trial with the clinician’s choice of a selective serotonin reuptake inhibitor at 6 primary care and 9 psychiatric clinical care settings in the National Institute of Mental Health–funded Depression Trials Network. Diagnosis of MDD was determined by the Psychiatric Diagnostic Screening Questionnaire and an MDD checklist based on DSM-IV-TR criteria. Suicidal ideation and behavior are 1 of 9 symptoms of MDD (depressed mood, loss of interest, appetite or weight change, sleep disturbance, reduced concentration or indecisiveness, fatigue or decreased energy, psychomotor agitation or retardation, feelings of worthlessness, or excessive guilt). The newly developed Concise Health Risk Tracking (CHRT) scale was administered both as the CHRT Self-Report (CHRT-SR) and Clinician Rating (CHRT-C) scales. Psychometric evaluations were conducted on both scales.

Results: The internal consistency (Cronbach α) was .77 for the 7-item CHRT-C and .78 for the 7-item CHRT-SR with a consistent factor structure, and 3 independent factors (current suicidal thoughts and plans, perceived lack of social support, and hopelessness) for both versions.

Conclusions: The 7-item CHRT-C and the 7-item CHRT-SR have excellent psychometric properties and can be used to monitor suicidal risk in clinical practice and research settings. Whether either scale will predict suicide attempts or completions in actual practice would require a very large prospective study sample.

Trial Registration: clincaltrials.gov Identifier: NCT00532103

J Clin Psychiatry 2011;72(6):757–764

Submitted: January 5, 2011; accepted March 18, 2011 (doi:10.4088/JCP.11m06837).

Corresponding author: Madhukar H. Trivedi, MD, Department of Psychiatry, The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9086 (Madhukar.Trivedi@UTSouthwestern.edu).