The Judgment of Future Suicide-Related Behavior
Helpline Counselors’ Accuracy and Agreement
Abstract
Background: Judging whether a youth is at risk for suicide-related behavior (SRB) is considered an extremely challenging task. There are only few studies of helpline counselors, and little is known about their ability to accurately determine the level of risk for SRB. Aims: To examine whether helpline counselors can agree on judgments of risk for SRB, and whether their judgments are consistent with youths’ actual behavior in a 6-month period following intake. Methods: 34 helpline counselors, recruited from three helplines, were studied. Information was collected on their judgments of risk for SRB for each of 45 youths over a 6-month period following initial intake. Results: Contrary to expectations, the counselors had a high rate of agreement (k = .56), and their risk judgments could be used quite successfully (80.0% correct classification) in identifying youths who later engaged in SRB. Conclusions: Unlike most other groups represented in the decision-making literature, helpline counselors agree and are accurate in their judgments of risk for SRB. Our findings suggest that it might be beneficial to apply some of the procedures used to train helpline clinicians to other types of clinicians. Further studies of helpline clinicians are suggested.
References
1991a). Manual for the Child Behavior Checklist/4–18 and 1991 Profile. Burlington, VT: University of Vermont Department of Psychiatry.
(1991b). Manual for the Youth Self-Report. Burlington, VT: University of Vermont Department of Psychiatry.
(2005). Deaths: Leading causes for 2002. National Vital Statistics Reports, 53, 1–90.
(1976). On the methods and theory of reliability. The Journal of Nervous and Mental Disease, 163, 307–317.
(1988). A generalization of Cohen’s κ agreement measure to interval measurement and multiple raters. Educational and Psychological Measurement, 48, 921–933.
(1995). Evaluating managed mental health services: The Fort Bragg Experiment. New York: Plenum.
(2006). Adolescent suicide and behavior. Journal of Child Psychology and Psychiatry, 47, 372–394.
(1955). Representative design and probabilistic theory in a functional psychology. Psychological Review, 62, 193–217.
(1960). A coefficient of agreement for nominal scales. Educational and Psychological Measurement, 20, 37–46.
(1996). Judgment analysis: Theory, methods, and applications. San Diego, CA: Academic Press.
(1992). Reliability and validity of the Suicide Intervention Response Inventory. Death Studies, 16, 79–86.
(2004). The role of representative design in an ecological approach to cognition. Psychological Bulletin, 130, 959–988.
(2000). Suicide: A call-sheet audit – Data from SANELINE. Psychiatric Bulletin, 24, 98–101.
(1998). Studying the clinician: Judgment research and psychological assessment. Washington, DC: American Psychological Association.
(2005). Clinical judgment and decision making. Annual Review of Clinical Psychology, 1, 67–89.
(2003). Youth suicide risk and preventative interventions: A review of the past 10 years. Journal of the American Academy of Child and Adolescent Psychiatry, 42, 386–405.
(2007). An evaluation of crisis hotline outcomes, Part 2: Suicidal callers. Suicide and Life-Threatening Behavior, 37, 338–352.
(2000). Clinical versus mechanical prediction: A meta-analysis. Psychological Assessment, 12, 19–30.
(1977). A probabilistic system for identifying suicide attempters. Computers and Biomedical Research, 10, 1–7.
(2000). Measuring doctors’ self-insight into their treatment decisions. Applied Cognitive Psychology, 14, 455–477.
(1982). The development of a child assessment interview for research and clinical use. Journal of Abnormal Child Psychology, 10, 173–189.
(1995). Can the clinician predict suicide? Psychiatric Services, 46, 449–451.
(1988). Psychiatrists’ accuracy in predicting violent behavior on an inpatient unit. Hospital and Community Psychiatry, 39, 1090–1094.
(2007). Establishing standards for the assessment of suicide risk among callers to the National Suicide Prevention Lifeline. Suicide and Life-Threatening Behavior, 37, 353–365.
(2007). An evaluation of crisis hotline outcomes, Part 1: Nonsuicidal crisis callers. Suicide and Life-Threatening Behavior, 37, 322–337.
(1982). Reliability and rationality in the prediction of suicide. Hospital and Community Psychiatry, 33, 212–215.
(1977). The measurement of observer agreement for categorical data. Biometrics, 33, 159–174.
(1977). Suicide prediction for psychiatric patients: A comparison of the MMPI and clinical judgments. Unpublished doctoral dissertation, Marquette University, Marquette, WI, USA.
(1981). Assessing paraprofessional competence with the Suicide Intervention Response Inventory. Journal of Counseling Psychology, 28, 176–179.
(1992). An empirical evaluation of three components of the tetrahedron model of clinical judgment. The Journal of Nervous and Mental Disease, 180, 560–565.
(1989). Developing strategies to prevent youth suicide. In , Suicide among youth: Perspectives on risk and prevention. Washington, DC: American Psychiatric Press.
(1996). Effectiveness of an outpatient intervention targeting suicidal young adults: Preliminary results. Journal of Consulting and Clinical Psychology, 64, 179–190.
(1987). Clinical judgments of suicide risk and optimal interventions. Unpublished manuscript, Bowling Green State University, Bowling Green, OH, USA..
(2004). Preventing suicide. QJM: An International Journal of Medicine, 97, 677–680.
(1971). Perturbation and lethality as precursors of suicide in a gifted group. Life Threatening Behavior, 1, 23–45.
(2007). Rebuilding the Tower of Babel: A revised nomenclature for the study of suicide and suicidal behaviors. Suicide and Life-Threatening Behavior, 37, 248–277.
(2006). Attempted and completed suicide in adolescence. Annual Review of Clinical Psychology, 2, 237–266.
(2008, April). Prediction of suicide-related behavior in youths. Paper presented at the American Association of Suicidology (AAS) Annual Conference, Boston, MA.
(2002). Mental health professionals’ determinations of adolescent suicide attempts. Suicide and Life-Threatening Behavior, 32, 284–300.
(1998). Interrater agreement among psychiatrists in psychiatric emergency assessments. American Journal of Psychiatry, 155, 1423–1428.
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