ORIGINAL ARTICLE Validation of the Computerized Suicide Risk Scale – a backpropagation neural network instrument (CSRS-BP) I. Modai 1 *, M. Ritsner 1 , R. Kurs 1 , S. Mendel 2 , A. Ponizovsky 2 1 Sha’ar Menashe Mental Health Center, Research Institute for Psychiatric Studies, Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel; 2 Rebecca Meirhoff Technical School, Tel Aviv University, Tel Aviv, Israel (Received 30 March 2000; revised 9 May 2001; accepted 20 June 2001) Summary – Background. Medicallyserioussuicideattemptshavebeenrecognizedasthemostimportantpredictorof suicide.TheComputerizedSuicideRiskScalebasedonbackpropagationneuralnetworks(CSRS-BP)hasbeenrecently found efficient in the detection of records of patients who performed medically serious suicide attempts (MSSA). Objectives. TovalidatetheCSRS-BPby:1)usingtheCSRS-BPwithpatientsinsteadofrecords;2)comparingtheability of expert psychiatrists to detect MSSA, using the CSRS checklist; and 3) comparing the results of the Risk Estimator for Suicide (RES) and the self-rating Suicide Risk Scale (SRS) with the CSRS-BP. Methods. Two hundred fifty psychiatric inpatients (35 MSSA and 215 non-MSSA) were diagnosed by clinicians using the SCID DSM-IV. Three expert psychiatrists completed the CSRS checklist, and the RES for each patient, and the patients completed the self-report SRS assessment scale. The CSRS-BP was run for each patient. Five other expert psychiatrists assessed the CSRS checklists and estimated the probability of MSSA for each patient. Comparisons of sensitivity and specificity rates between CSRS-BP, assessment scales and experts were done. Results. Initially, the CSRS-BP, RES, SRS, and experts performed poorly. Although sensitivity and specificity rates significantly improved (two to four times) after the inclusion ofinformationregardingthenumberofprevioussuicideattemptsintheinputdataset,resultsstillremainedinsignificant. Conclusions. TheCSRS-BP,whichwasverysuccessfulinthedetectionofMSSApatientrecords,failedtodetectMSSA patients in face-to-face interviews. Information regarding previous suicide attempts is an important MSSA predictor, but remains insufficient for the detection of MSSA in individual patients. The detection rate of the SRS and RES scales was also poor and could therefore not identify MSSA patients or be used to validate the CSRS-BP. © 2002 Éditions scientifiques et médicales Elsevier SAS CSRS / MSSA detection / RES / SRS INTRODUCTION In the past few decades, numerous scales for assessing and predicting suicide have been developed for clinical and research use. Most widely used are the Scale for Assessing Suicide Risk (SARS) [30], Los Angeles Sui- cide Prevention Center Scale (LASPC) [3], Suicide Intent Scale (SIS) [3], Suicide Death Prediction Scale (SDPS) [3], Index of Potential Suicide (IPS) [33], Estimator for Suicide Risk (ESR) [25], and Suicide Risk Scale (SRS) [26]. In a review study [22], the SDPS and the ESR were considered the most accurate in predicting individual suicide outcome in a small biased sample of five clinical cases. *Correspondence and reprints. E-mail address: shrmodai@matat.health.gov.il (I. Modai). Eur Psychiatry 2002 ; 17 : 75-81 © 2002 Éditions scientifiques et médicales Elsevier SAS. All rights reserved S0924933802006314/FLA