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Open Access Highly Accessed Research article

Detecting suicidality among adolescent outpatients: evaluation of trained clinicians' suicidality assessment against a structured diagnostic assessment made by trained raters

Matti Mikael Holi12*, Mirjami Pelkonen13, Linnea Karlsson1, Virpi Tuisku13, Olli Kiviruusu1, Titta Ruuttu13 and Mauri Marttunen134

Author Affiliations

1 Department of Mental Health and Alcohol Research, National Public Health Institute, Helsinki, Finland

2 Kellokoski Hospital, Kellokoski, Finland

3 Department of Psychiatry, Peijas Hospital, Helsinki University Central Hospital, Helsinki, Finland

4 Department of Psychiatry, University of Kuopio, Kuopio, Finland

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BMC Psychiatry 2008, 8:97  doi:10.1186/1471-244X-8-97

Published: 31 December 2008



Accurate assessment of suicidality is of major importance. We aimed to evaluate trained clinicians' ability to assess suicidality against a structured assessment made by trained raters.


Treating clinicians classified 218 adolescent psychiatric outpatients suffering from a depressive mood disorder into three classes: 1-no suicidal ideation, 2-suicidal ideation, no suicidal acts, 3-suicidal or self-harming acts. This classification was compared with a classification with identical content derived from the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS-PL) made by trained raters. The convergence was assessed by kappa- and weighted kappa tests.


The clinicians' classification to class 1 (no suicidal ideation) was 85%, class 2 (suicidal ideation) 50%, and class 3 (suicidal acts) 10% concurrent with the K-SADS evaluation (γ2 = 37.1, df 4, p = 0.000). Weighted kappa for the agreement of the measures was 0.335 (CI = 0.198–0.471, p < 0.0001). The clinicians under-detected suicidal and self-harm acts, but over-detected suicidal ideation.


There was only a modest agreement between the trained clinicians' suicidality evaluation and the K-SADS evaluation, especially concerning suicidal or self-harming acts. We suggest a wider use of structured scales in clinical and research settings to improve reliable detection of adolescents with suicidality.