The 9-item Concise Health Risk Tracking – Self-Report (CHRT-SR₉) measure of suicidal risk: Performance in adult primary care patients

Purpose: To evaluate the psychometric properties of a 9-item Concise Health Risk Tracking Self-Report (or CHRT-SR₉) to assess suicidal risk in adult primary care outpatients. Methods: Overall, 369 adults completed the original 14-item version of CHRT-SR at baseline and within 4 months thereafter, from which the CHRT-SR₉ was extracted using multigroup confirmatory factor analysis. Measurement invariance (across age and sex) and classical test theory characteristics of the CHRT-SR₉ were evaluated. Concurrent validity was assessed by comparing CHRT-SR₉ responses to those of the suicide item in the Patient Health Questionnaire (PHQ-9), both cross-sectionally and as a change measure over time. Results: Confirmatory factor analysis identified the CHRT-SR₉ as the optimal solution. Factors included pessimism, helplessness, despair (2 items each) and suicidal thoughts (3 items). Measurement invariance held across sex and age groups, indicating that mean differences among sub-groups were real and not attributable to measurement bias. Classical test theory revealed acceptable item-total correlations overall (0.57–0.79) and internal consistency (Spearman–Brown from 0.76 to 0.90). Concurrent validity analyses revealed that the CHRT-SR₉ can measure both improvement and worsening of suicidality over time. A PHQ-9 response of 0, 1, 2, and 3 on the suicide item corresponded to 7.82 (5.53), 16.80 (4.99), 20.71 (5.36), and 25.95 (7.30) (mean and SD) on CHRT-SR₉ total score, respectively. Conclusion: The CHRT-SR₉ is a brief self-report evaluating suicidality with excellent psychometric properties that is sensitive to change over time.