medRxiv : the preprint server for health sciences · 2026
Psychometric Properties and Continuous National Norms of the Parent-Report Concise Health Risk Tracking Assessment: Charting Pediatric Suicide Risk Across Age and Sex.
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Deericks Halle, Youngstrom Eric A, Westlund Schreiner Mindy
Аннотация
OBJECTIVE: The Concise Health Risk Tracking (CHRT) assessment has utility in suicide risk prediction in adults and adolescents. Because multi-informant assessment is the gold standard in pediatric populations, a parent report version of the CHRT may enhance evaluation of youth suicide risk. We adapted the self-report version of the 16-item CHRT as a parent report version (CHRT-PR 16 ) and evaluated the psychometric properties and continuous age- and sex-specific norms in a nationally representative sample of parents.
METHOD: Parents of youth aged 6-18 years (N=2,236; 2,235 in sex-stratified analyses) completed the CHRT-PR 16 , enabling evaluation of both the 16- and 14-item (CHRT-PR 14 ) version. Psychometric analyses included internal consistency, factor structure, Item Response Theory, measurement invariance, criterion validity, and continuous norming using Generalized Additive Models for Location, Scale and Shape (GAMLSS).
RESULTS: Internal consistency was excellent for both CHRT-PR 16 and CHRT-PR 14 (both ω t =.98, α =.96), although general factor variance was higher for CHRT-PR 14 ( ω H =.83) than CHRT-PR 16 ( ω H =.68). Mokken scale analysis confirmed zero monotonicity violations for CHRT-PR 14 . CHRT-PR 16 showed a clinically trivial edge in criterion correlations with other measures of psychopathology. In GAMLSS modeling, a zero-inflated negative binomial distribution achieved optimal fit for both scales. Score trajectories diverged by age and sex around age 10, with males scoring slightly higher at upper percentiles.
CONCLUSIONS: CHRT-PR 16 and CHRT-PR 14 demonstrate strong psychometric support, essential unidimensionality, measurement invariance, and optimal GAMLSS fit. Age- and sex-specific percentile lookup tables provide population-level benchmarks to guide measurement-based care, symptom tracking, and suicide risk stratification in pediatric settings.
METHOD: Parents of youth aged 6-18 years (N=2,236; 2,235 in sex-stratified analyses) completed the CHRT-PR 16 , enabling evaluation of both the 16- and 14-item (CHRT-PR 14 ) version. Psychometric analyses included internal consistency, factor structure, Item Response Theory, measurement invariance, criterion validity, and continuous norming using Generalized Additive Models for Location, Scale and Shape (GAMLSS).
RESULTS: Internal consistency was excellent for both CHRT-PR 16 and CHRT-PR 14 (both ω t =.98, α =.96), although general factor variance was higher for CHRT-PR 14 ( ω H =.83) than CHRT-PR 16 ( ω H =.68). Mokken scale analysis confirmed zero monotonicity violations for CHRT-PR 14 . CHRT-PR 16 showed a clinically trivial edge in criterion correlations with other measures of psychopathology. In GAMLSS modeling, a zero-inflated negative binomial distribution achieved optimal fit for both scales. Score trajectories diverged by age and sex around age 10, with males scoring slightly higher at upper percentiles.
CONCLUSIONS: CHRT-PR 16 and CHRT-PR 14 demonstrate strong psychometric support, essential unidimensionality, measurement invariance, and optimal GAMLSS fit. Age- and sex-specific percentile lookup tables provide population-level benchmarks to guide measurement-based care, symptom tracking, and suicide risk stratification in pediatric settings.