Development and implementation of a self-report screening instrument for suicidality among adolescents age 12-21 of diverse ethnic / cultural backgrounds. (main study includes adolescents age 18-21 only)

In the Netherlands annually an average of 46 youths up to the age of 19 die
because of suicide. There is a need for a self-report
instrument for suicide ideation among teenagers age 12 * 21. Moreover there is
a need for an instrument that is invariant for ethnicity.
Suicidal behaviour occurs among adolescents of diverse cultural backgrounds.
Schools and youth health services are aware of signs of
suicidality among youths and want to select those that require immediate
attention and help. There is no valid Dutch instrument in
youth care and in youth-GGZ on which decisions for treatment can be made. The
instrument should also become available as a selftest
on the internet. Many adolescents are surfing the internet anonymously in
search for information and advice about suicide.

The present research protocol aims at the development and implementation of a
valid self-report instrument for suicidality among
adolescents. The instrument needs to be invariant for ethnicity and needs to
register fluctuations in suicide risk and determine changes
over time as a measure for improvement in the treatment in youth-GGZ.
The importance of identification of suicidality lies in the fact that untreated
suicidality can result in continuing and deterioration of
emotional problems, suicide attempts and suicide. Both health benefits (faster
and more validated risk assessment) and cost reduction
(faster assisstance, no unnecessary referrals) are achieved. The development of
an instrument for suicidality will alert policy on the
issue of adolescents with better information about their living situation.

1. Inventory of existing screening instruments and formulation item pool.
Period May 2009 - August 2009: Based on foreign screening tools, clinical
experience of experts and theoretical considerations an item pool was
constructed from questions about suicidal thoughts and behaviours and risk
indicators for suicidality.

2. testing item pool. January 2010 - December 2012: The item pool is presented
to both adolescents under treatment of mental health care services and
adolescent's going to school. With the obtained data, the item pool will be
reduced, which allows further test construction.

3. Standardization and predictive value of instrument. Period June 2013 - May
2014: The preliminary instrument will be tested for predictive value with 4000
youngsters of 18 to 21 years (50% girls). The tool will be included in this
study over a period of 3 months (2 measurements) and related to subsequent
developments (self-harm or suicide attempts, the course of depression).
Furthermore the influence of demographic factors such as ethnicity and
environmental factors on the prediction will be examined. Convergent validity
is examined with simultaneous assessment with questionnaires on suicide
ideation, depression, hopelessness, impulsivity and hostility.

4. Scientific report and documentation test construction. Period Januari 2014 -
December 2014.

It could be hypothesised that answering questions about suicidality could
instigate suicidal thoughts or even suicidal behaviour.
However, this hypothesis is not scientifically validated in psychology and
psychiatry. Gould et al. (2005) studied the effects associated
with completing a self-report instrument for suicidality. In this study no
iatrogenic effects were found.
In the present research the assessment is short in time, though it will
encourage the subjects to reflect on own
psychological well-being and possible suicidal ideation. Through follow-up
appointments possible psychological burden will be
identified and minimized, and if necessary, it can lead to referral to youth
mental health care.