A Psychometric Evaluation of the Cultural Assessment of Risk for Suicide Shortened-Screener Among Black Women

Background and Purpose: Although suicide rates among Black women have increased in the last decade (Price & Khubchandani, 2019), few brief culturally tailored and validated assessment tools exist to identify suicide risk in this population. The Cultural Assessment of Risk for Suicide Shortened Screener (CARS-S) assesses culturally specific suicide risk across four categories: Cultural Sanction, Idioms of Distress, Minority Stress, and Social Discord (Chu et al., 2013). While CARS-S has demonstrated excellent psychometric performance in prior research, it remains unclear whether this brief suicide assessment tool is applicable to Black women, whose experiences of suicide risk are often shaped by cultural and intersectional factors. The current study examines the structural validity of the Cultural Assessment of Risk for Suicide Screener (CARS-S) in a sample of Black women.

Method: Data were collected from (n=300) Black women aged 18 or older across the United States between December 2025 and January 2026. A confirmatory factor analysis (CFA) was conducted to examine the factor structure of the CARS-S.

Results: A CFA was conducted to evaluate the applicability of the previously established four-factor (i.e., Minority stress (three items), Social Support (four items), Idioms of distress (three items), and Cultural Sanctions (three items)) structure in the current sample of Black women. The model produced an inadmissible solution, as indicated by a non-positive definite covariance matrix and an estimated latent correlation exceeding acceptable bounds (r = -1.008). Additionally, several items demonstrated weak or non-significant factor loadings, and modification indices suggested substantial cross-loading and model misspecification. Although approximate fit indices fell within marginally acceptable ranges (RMSEA = .067), incremental fit indices were below recommended thresholds (CFI = .871, TLI = .829). Taken together, these findings indicate that the existing factor structure does not adequately represent the underlying construct relationships in this population.

Implication and Conclusion: The study’s findings suggest that the original CARS-S factor structure does not adequately capture the cultural dimensions of suicide risk among Black women, raising an important concern about the applicability of this established measure across marginalized groups. These findings are also concerning because of the increased suicide rates among Black women. The continued use of the CARS-S with these women when it appears that this scale is not reliable, valid, and culturally accurate creates a missed opportunity to provide timely intervention and prevention strategies to support Black women while reducing their cultural risk for suicide. For social work researchers, these results suggest the need for more rigorous, culturally responsive psychometric evaluation, including further validation and refinement of the CARS-S to better reflect the lived experiences and intersectional identities of Black women. Finally, these results highlight the importance of ensuring that measurement tools used in research and clinical practice are methodologically rigorous and equitable.