Assessing suicidal ideation and behaviors among childhood
brain tumor survivors and their mothers: incorporating the
Columbia-Suicide Severity Rating Scale (C-SSRS)
1
RN ;
1
APRN ;
1,2
PMHCNS-BC ;
Matthew S. Lucas, MA,
Bridgette M. Brawner, PhD,
Thomas L. Hardie, EdD,
Cynthia Paidipati, MSN1; Magdaline Diaz1; Amy Levin1; Wendy L. Hobbie, MSN, CRNP, FAAN1,3; Janet A. Deatrick, PhD, RN, FAAN1
1Center
for Health Equity Research, University of Pennsylvania School of Nursing, Philadelphia, PA, USA, 2Widener University
School of Nursing, Chester, PA, USA, 3Cancer Survivorship Program, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
University of Pennsylvania School of Nursing
Center for Health Equity Research
TOPIC
As part of a study of survivors of childhood
brain tumors (n=109) and their caregivers
(n=142), suicidal ideation and behaviors were
noted among the study participants. In order
to address this potential ethical issue, the
research team developed a protocol to
assess both survivors and their mothers who
expressed suicidal tendencies.
•Evaluation of suicide assessment tool in a
special population
•Assess the difference between nonthreatening ideation & need for intervention
IMPLEMENTATION
The Columbia-Suicide Severity Rating Scale
(C-SSRS) was utilized to evaluate the
appropriate level of intervention by nonpsychiatrically trained researchers for subjects
who expressed suicidal ideation or behaviors.
It has shown success in assessing subjects
who endorsed suicidal ideation during initial
phone interviews and was adapted for use in
face-to-face contact in the home.
The
protocol includes follow-up with an on-call
mental health professional.
Brief Symptom Inventory (BSI):
Subjects endorse Thoughts of
Ending Life
Yes
Suicide
Endorsed
Yes
Can subject
complete the
interview?
Stop Interview
Complete
Columbia-Suicide
Severity Rating
Scale (C-SSRS)
No
No
n
% endorsed, study pop.
% endorsed, general pop.
endorsed age (yrs)
study pop. age
endorsed time since dx (yrs)
study pop. time since dx
Caregivers
4
2.82
14.5*
16.71 ± 2.14
21.12 ± 4.42
10.50 ± 4.48
13.29 ± 5.05
15.6‡
50.33 ± 2.52
51.01 ± 5.91
14.83 ± 4.25
13.44 ± 5.63
*US adolescents, grades 9-12, 2007, CDC, MMWR, 6 June 2008
‡US adults, 2002-03, Nock et al. (2008), Br J Psychiatry 192(2):98-105
Complete
Interview
• Call 911
• Report
participants’
suicide risk
• Do not hang up
until instructed
•Call 911
•Report
participants’
suicide risk
Yes
Is there an
immediate
risk?
No
Ideations with plans/
suicidal behavior
•Suggest
contacting a
mental health
professional
•Suicide hotline:
1-(800)-SUICIDE
•Do not hang up
until instructed
•Inform of followup by research
team
SAMPLE DESCRIPTION
Survivors
7
6.42
OUTCOMES
•Continue
interview if
appropriate
Contact PI within one
business day for consults
and non-urgent issues
•11 subjects (7 survivors, 4 caregivers)
endorsed suicidal ideation and were
screened
•All received follow-up by a mental health
professional and referral to services
•Process notes contained the following
themes about the subjects:
• Survivor: anger and/or sadness;
• Caregiver: physical and emotional
demands of the survivor;
• Interviewer: reiteration of event,
successful assessment, and the mental
health professional agreed with the CSSRS referral algorithm
RECOMMENDATIONS
Address potential ethical issues in research
and practice.
Research:
•C-SSRS assists detecting suicide risk
•Feasible to implement within a protocol by
non-psychiatrically trained researchers
•Helps direct need for intervention
Practice:
•Possible use in the clinical setting
•Potential feasibility as a screen to determine
need for intervention
ACKNOWLEDGMENTS
Supported by the Graduate Scholarship in Cancer Nursing Practice
GSCNP-09-236-01-SCN from the American Cancer Society (MSL);
the National Institutes of Health T32-NR007100 (MSL) and R01NR00965 (JAD, WLH); and the Oncology Nursing Society Neurooncology Nursing Research Grant (JAD, WLH).