The Concise Health Risk Tracking Self-Report (CHRT-SR): Psychometric Properties of a Measure to Identify Suicidality in a Treatment Seeking Population with Stimulant Use Disorder

Purpose

Stimulant use disorders are prevalent and often co-occur with other psychiatric disorders, and long tern use is associated with hopelessness, depression and suicidality. It has been suggested that stimulant users should be monitored for suicidal behavior, yet, to date, no comprehensive suicide risk scale has been validated for use with a stimulant using population. The Concise Health Risk Tracking Scale Self-Report (CHRT-SR; Trivedi et al., 2011) was developed as a self-report measure to assess suicidal propensity and risk in patients with major depressive disorder. The current project seeks to test the test-retest reliability as well as the construct and criterion-related validity of the CHRT-SR.

Methods

The current study examined baseline and subsequent assessment from the Stimulant Reduction Intervention using Dosed Exercise (STRIDE) study, a multicenter randomized control trial of treatment-seeking stimulant users recruited from residential treatment centers. In order to be enrolled in STRIDE, participants met DSM-IV criteria for stimulant abuse or dependence within the last 12 months, reported illicit stimulant drug use within the 30 days prior to admission and had to be medically cleared to exercise via a protocol-defined stress test. Participants were assessed with the 7-item CHRT-SR, which includes subscales of Hopelessness, Social Support, and Risk. The MINI International Neuropsychiatric Interview was used to obtain diagnostic information for other DSM-IV Axis I disorders and suicidal risk. Symptoms of depression were assessed with the 16-item Quick Inventory of Depressive Symptomatology-Clinician Rated version (QIDS-C16). Cronbach 𝛼 (internal consistency reliability) was calculated for the total CHRT and three subscales. Intraclass correlation coefficients (ICC) were used to examine for test-retest reliability. Tests of construct and criterion-related validity of the CHRT included Spearman’s rho, Kruskal-Wallis ANOVA, and Mann-Whitney U tests.

Results

Participants were adult stimulant users (N=302), aged 18-65, with a mean age of 39 years (SD=10.8). The sample was 40% (n=121) female, 50% (n=148) White and 46% (n=138) Black. The mean education level was 12.4 years (SD=2.0), with 53.3% never married, and 31.5% currently employed. CHRT-SR subscales and total scores demonstrated good to very good internal consistency reliability with Cronbach’s coefficient 𝛼 for each dimension greater than .7, and Hopelessness subscale 𝛼 = .869 and Risk 𝛼 = .892. The CHRT-SR total had an obtained 𝛼 = .775. Acceptable test-retest reliability between the baseline and subsequent time point was found (ICC = .705). Significant differences on the CHRT-SR were found between groups on participants diagnosed with depression, anxiety, suicidality and related disorders. Those participants assessed as currently suicidal reported significantly higher scores on the CHRT-SR total (U = 11382.0, p = .034).

Conclusion

This study furthers the findings of the previously established strong psychometric properties of the CHRT-SR, and supports its clinical utility as a measure of suicidal thoughts and associated symptoms for people with stimulant use disorder. The 7-item CHRT-SR offers particular utility as simple and quick assessment of hopelessness and pessimism, symptoms common among people with chronic stimulant use, and might add predictive value for a population who should be closely monitored for suicide risk.