ORIGINAL RESEARCH article
Front. Psychiatry
Sec. Adolescent and Young Adult Psychiatry
This article is part of the Research TopicMechanisms and Non-Pharmacological Interventions for Adolescent Mood DisordersView all 7 articles
Validity of the Tree Drawing Test Suicide Ideation Assessment Scale in Adolescents
Provisionally accepted
- 1Suzhou Guangji Hospital, Suzhou, China
- 2No. 905 Hospital of PLA Navy, Shanghai, China
- 3Jiangsu University, Zhenjiang, China
- 4Zhenjiang College, Zhenjiang, China
- 5Second Affiliated Hospital of Naval Medical University, Shanghai, China
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Objective: To examine the validity of the Tree Drawing Test Suicide Ideation Assessment Scale (TDT-SIAS) for screening suicidal ideation in adolescents. Methods: A case–control design was employed, involving 36 adolescents with suicidal ideation and 58 adolescents without suicidal ideation. All participants completed the Tree Drawing Test, and their responses were analyzed using computer-based image recognition and data acquisition techniques with the TDT-SIAS. Statistical analyses were then conducted. Results: Significant differences were observed in total scores between the suicidal ideation group and the non-suicidal group (p < 0.001). Using a cutoff score of 9, the Youden Index was 0.901, with a sensitivity of 0.935, specificity of 0.966, positive predictive value of 0.956, and negative predictive value of 0.949. Inter-rater reliability (Cohen's kappa) ranged from 0.779 to 0.961. Conclusion: The TDT-SIAS demonstrated good screening performance and effectively distinguished adolescents with suicidal ideation from those without. It may serve as a preliminary screening tool for adolescent suicidal ideation. However, limitations of this study include the relatively small sample size and the lack of consideration for cultural differences, which may affect generalizability. Future studies should expand sample size and examine cross-cultural applicability.
Keywords: Projective test, Tree drawing test, suicide ideation assessment, adolescents, reliability and validity
Received: 09 Sep 2025; Accepted: 11 Nov 2025.
Copyright: © 2025 Liu, Liu, Liu, Li and Zhang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Yanfei Zhang, zhangfly@smmu.edu.cn
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