Structured assessment of suicide risk in a psychiatric emergency service: Psychometric evaluation of the Nurses' Global Assessment of Suicide Risk scale (NGASR).

BACKGROUND: Risk of suicide is notoriously difficult to assess, and no gold standard is available, in terms of an instrument of first choice. Many different instruments are in use, among which are some that are not properly psychometrically investigated. AIM: The aim of this study is to establish the psychometric properties of the Dutch version of the Nurses' Global Assessment of Suicide Risk scale (NGASR), and the feasibility of its use in assessing suicide risk. Therefore, our research questions are as follows: what is the reliability, validity, interpretability and feasibility of the NGASR? METHODS: A psychometric study of acceptability, reliability and predictive validity among 252 patients making use of a concurrent instrument, the Suicide Intention Scale (SIS), concurrent assessment by a physician and 6-month follow-up. RESULTS: Factor analysis identified five factors. Cronbach's alpha was .45. Intraclass correlation was .92 (95% confidence interval (CI) = .85-.95). Association between total NGASR and SIS was substantial and significant (B = 0.66, standard error of mean (SE) = 0.19, ß = .66, p = .003). NGASR total score had a significant and moderately strong association with judgement by a physician on 'suicidal thoughts' (odds ratio (OR) = 1.24, p = < .001) or 'suicidal thoughts or plans' (OR = 1.35, p = .001). No significant association of NGASR scores and 6-month follow-up of suicidality was found. CONCLUSIONS: Internal consistency of the NGASR and most of the subscales identified was low. Other indicators of reliability of the NGASR were sufficient, although predictive validity was poor. The NGASR did not outperform other instruments but is easy to use, and may contribute to identification of risk factors, as well as to a more integral assessment of suicide risk.

Effects of improved patient participation in primary care on health-related outcomes: a systematic review.

BACKGROUND: In primary care, many consultations address symptom-based complaints. Recovery from these complaints seldom exceeds placebo effects. Patient participation, because of its supposed effects on trust and patient expectancies, is assumed to benefit patients' recovery. While the idea is theoretically promising, it is still unclear what the effects of increased patient participation are on patient outcomes. Aim. To review the effects of controlled intervention studies aiming to improve patient participation in face-to-face primary care consultations on patient-oriented and/or disease-oriented outcomes. METHODS: This study is a systematic review. A systematic search was undertaken for randomized controlled trials designed to measure the effects of interventions that aimed to improve adult patients' participation in primary care visits. The CINAHL, Cochrane, EMBASE, PsycINFO and PubMed databases were searched. RESULTS: Seven different trials fulfilled the inclusion criteria. Three of the studies were related to symptom-based complaints. Five studies measured patient-oriented outcomes, the primary outcome of interest for this review. All studies suffered from substantial bias. Studies varied widely in their aims, types of complaints/diseases, strength of the interventions and their outcomes. The effects on patient-oriented outcomes and disease-oriented outcomes were ambiguous. CONCLUSION: Little research has been performed on health outcomes of interventions aiming to increase patient participation in general practice visits among patients suffering from symptom-based complaints. The results still are non-conclusive. The quality of the trials has been weak, possibly due to the complexity of the concept. This weak quality may explain the lack of conclusive results. Proposals for future research designs are offered.