Hostname: page-component-c4975b477-p22xc Total loading time: 0 Render date: 2023-09-21T10:26:51.950Z Has data issue: false Feature Flags: { "corePageComponentGetUserInfoFromSharedSession": true, "coreDisableEcommerce": false, "coreDisableSocialShare": false, "coreDisableEcommerceForArticlePurchase": false, "coreDisableEcommerceForBookPurchase": false, "coreDisableEcommerceForElementPurchase": false, "coreUseNewShare": true, "useRatesEcommerce": true } hasContentIssue false

The Suicide Risk Assessment and Management Manual (S-RAMM) Validation Study 1

Published online by Cambridge University Press:  13 June 2014

Atif Ijaz
Affiliation:
Central Mental Hospital, Dundrum, Dublin 14, Ireland
Alexia Papaconstantinou
Affiliation:
Central Mental Hospital, Dundrum, Dublin 14, Ireland
Helen O'Neill
Affiliation:
Central Mental Hospital, Dundrum. Dublin 14, Ireland
Harry G Kennedy*
Affiliation:
Clinical Professor of Forensic Psychiatry (University of Dublin, Trinity College, Dublin, Ireland) and Central Mental Hospital, Dundrum, Dublin 14, Ireland
*
*Correspondence E-mail: Harry.kennedy@ireland.com

Abstract

Objective:

There are validated tools for structured professional judgement of risk of violence, but few for risk of suicide. The Suicide Risk Assessment and Management Manual (S-RAMM) is a new structured professional judgement tool closely modelled on the HCR-20. This is the first validation study for the S-RAMM. We measured inter-rater reliability, internal consistency, concurrent validity with another validated risk instrument (HCR-20) and with a measure of psychopathology (PANSS). We tested whether the tool could distinguish between groups of patients clinically assessed as at varying levels of risk of suicide or self harm.

Method:

Two researchers jointly interviewed 25 current in-patients for inter-rater reliability (Cohen's kappa) and internal consistency (Cronbach's alpha) and interviewed 81 of 83 current in-patients to assess whether the mean scores for different wards were significantly different (using ANOVA). Two other researchers made independent ratings of the HCR-20 and PANSS.

Results:

Inter-rater reliability was acceptable for all items (Cohen's kappa >0.5 for all but three items) and all sub-scale and total scores (Spearman correlations all >0.8). Internal consistency was high, (Cronbach's alpha all sub-scales >0.6). Scores stratified significantly with high scores for admission and intensive care units and progressively lower scores in rehabilitation and predischarge units. The HCR-20 historical and S-RAMM background scores did not correlate but the dynamic sub-scales correlated significantly. PANSS scores also correlated significantly with S-RAMM scores.

Conclusion:

The S-RAMM has better than minimum acceptable characteristics for use as a clinical or research tool. Prospective studies of sensitivity and specificity are now required.

Type
Original Papers
Copyright
Copyright © Cambridge University Press 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Webster, CD, Douglas, KS, Eaves, D, Hart, SD. HCR-20: Assessing risk for violence,version 2. Burnaby, British Colombia: Simon Fraser University, 1997.Google Scholar
2.Bouch, J, Marshall, JJ. S-RAMM Suicide Risk Assessment and Management Manual (Research Edition) Cardiff: The Cognitive Centre Foundation, 2003.Google Scholar
3.Risk Management Authority of Scotland. Risk Assessment Tools Evaluation Directory (RATED) version 1. Scotland: Astron. 2006. www.rmascotland.gov.ukGoogle Scholar
4.Fagan, J, Ijaz, A, Papaconstantinou, A, Lynch, AO'Neill, H, Kennedy, HG. The suicide risk assessment and management manual (S-RAMM) validation study II: prospective study of a structured professional judgement tool for suicide risk assessment. Ir J Psychol Med 2009; 26(3).CrossRefGoogle Scholar
5.Kay, SR, Fiszbein, A, Opler, LA. The positive and negative syndrome scale (PANSS) for schizophrenia. Schiz Bull 1987; 13: 261277.CrossRefGoogle Scholar
6.Daffern, M, Howells, K. The prediction of imminent aggression and self-harm in personality disordered patients of a high security hospital using the HCR-20 clinical scale and the dynamic appraisal of situational aggression. Int J Forensic Ment Health 2007; 6: 137143.CrossRefGoogle Scholar
7.Pillay, SM, Oliver, B, Butler, L, Kennedy, HG. Risk stratification and the care pathway. Ir J Psychol Med 2008; 25(4): 123127.CrossRefGoogle Scholar
8.Norusis, M. SPSS for Windows versionl 12.0.1 (11 November 2003). Chicago: SPSS Inc. 2004.Google Scholar
9.Appleby, L. Safety First: Five-Year Report of the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. London: Department of Health, 2001.Google Scholar
10.Maden, TTreating violence: a guide to risk management in mental health. Oxford: Oxford University Press, 2007.CrossRefGoogle Scholar