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

Published online by Cambridge University Press:  13 June 2014

Atif Ijaz ,
Alexia Papaconstantinou ,
Helen O'Neill  and
Harry G Kennedy
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: [email protected]
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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.

Keywords

SuicideViolenceRiskAssessmentStructured Professional JudgementValidityS-RAMMHCR-20
Type
Original Papers
Information
Irish Journal of Psychological Medicine , Volume 26 , Issue 2 , June 2009 , pp. 54 - 58
Copyright
Copyright © Cambridge University Press 2009

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