Computerized Surveys Help Diagnose Depression and Suicide Risk in Youths

David Shaffer, M.D.
David Shaffer, M.D.

From The Quarterly, Spring 2013

When he first heard about it in the late 1970s, David Shaffer, M.D., remembers being not only “skeptical” but in a state of disbelief. Just as his career in psychiatry was getting under way, an important study found that people with suicidal thoughts were least likely to give honest replies in face-to-face interviews, somewhat more likely in written questionnaires, but most likely to tell the truth in impersonal computer-administered tests.

Dr. Shaffer’s own first groundbreaking study of youth suicides had nothing to do with computers. It was carried out in his native Great Britain using data gathered from official records. Sadly, the subjects were dead; yet the data revealed a fact which changed public attitudes. “What emerged was that you could catch suicide; it could be suggested by various signs and clues, and thus it could be prevented.”

He and other pioneers discovered that suicidal ideation is remarkably common —it’s routinely found in 25% of U.S. high school students. Actual suicides, though rare, can occur in local waves, the “cluster effect,” and this happens in part because imitation, as Dr. Shaffer discovered, plays an important role.

Dr. Shaffer’s insights, including the importance of aggressive behavior in identifying youths most at risk, as well as co-morbidities including not only depression but also alcohol use and anxiety, have been woven into the fabric of diagnostic “survey instruments” he has devised which are used across the U.S. and in many other nations. He was the lead investigator in developing the Children’s Global Assessment Scale (C-GAS), and led a team that developed the Diagnostic Interview Schedule for Children (DISC), and in the late 1990s, the Columbia Teen Screen.

Dr. Shaffer suspects that disruptions of the serotonin neurotransmitter system are important in the biological underpinnings of suicidal thinking and behavior. “Serotonin acts as a sort of shock absorber of emotion,” he says. He is deeply impressed with recent Danish studies demonstrating the importance of outpatient follow-up for youths admitted for suicidal behavior.

Dr. Shaffer notes, too, the importance of getting high schools to allow students to be screened annually for suicide risk, and says more suicides could be prevented if permission were granted—it rarely is—for brief computer-administered questionnaires seeking to identify acute anxiety and aggression. He reminds that the clearest identifier of a youth—typically an adolescent male—who might indeed carry out a self-destructive act is the admission that he has planned where and when to do the deed. “Agitation, unrest, anxiety, alcohol, and planning: these are what you want to watch out for,” Dr. Shaffer advises.

David Shaffer, M.D.
Irving Philips Professor of Child Psychiatry
College of Physicians & Surgeons, Columbia University; Professor of Psychiatry and Pediatrics and Chief, Division of Child and Adolescent Psychiatry, Columbia University Medical Center; Attending Psychiatrist and Chief, Department of Pediatric Psychiatry, New York Presbyterian Hospital;
1992 NARSAD Distinguished Investigator Grantee,
2006 Brain & Behavior Research Foundation Ruane Prize for Outstanding Achievement in Child and Adolescent Psychiatric Research

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