Innovations In Clinical Neuroscience

SEP-OCT 2014

A peer-reviewed, evidence-based journal for clinicians in the field of neuroscience

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by JENNIFER M. GIDDENS and DAVID V. SHEEHAN, MD, MBA J. Giddens is Co-founder of the Tampa Center for Research on Suicidality, Tampa, Florida; and Dr. Sheehan is Distinguished University Health Professor Emeritus, University of South Florida College of Medicine, Tampa, Florida. Innov Clin Neurosci. 2014;11(9–10):164–171 Innovations in CLINICAL NEUROSCIENCE [ V O L U M E 1 1 , N U M B E R 9 – 1 0 , S E P T E M B E R – O C T O B E R 2 0 1 4 ] 164 ABSTRACT Objectives: This paper investigates the relationship between total scale scores and some other measures used to assess global severity of suicidality in order to determine if "global assessment" can be accomplished with one metric or if is it necessary to judge severity of suicidality in a multidimensional fashion. Methods: For over a year, one subject with daily suicidality self- rated a global severity of suicidality score, the time spent in suicidality over 31,183 events of suicidality, the Sheehan-Suicidality Tracking Scale, Hopelessness Spectrum measure, and the Suicide Plan Tracking Scale. Results: Relying on only one or two metrics to assess global severity of suicidality appears to have significant limitations. As with all single case reports, the findings may not be generalizable to other cases of suicidality. Conclusion: At the middle to high end of the suicidality spectrum, it is necessary to rely on multiple metrics, not just a global severity of suicidality rating, to properly assess the overall severity of suicidality. INTRODUCTION Multidimensional rating scales are traditionally used to capture the range of symptoms, symptom groupings, signs, and phenomena of a psychiatric disorder. A measure of global severity "has the advantage of being a summary that allows the rater to combine the elements of psychopathology into a single meaningful index of severity of illness." 1 In many studies, global ratings are reported to be "more sensitive to differential treatment effects than do measures of single dimensions of psychopathology." 2 Clinicians have relied on a single scale or a single item or a few questions to assess overall suicidal severity. Some use a single dimension global assessment of suicidality severity as a reference anchor against which to judge suicidality scales or other suicidality metrics as if the single dimension global measure of severity is a standard against which all else should be judged. Researchers want to know how the total score on any scale relates to global severity ratings of the same variable set. The expectation is that the relationship will be strong, high, and, hopefully, an ascending linear FUNDING: There was no funding for the development and writing of this article. FINANCIAL DISCLOSURES: J. Giddens is the author and copyright holder of the Suicide Plan Tracking Scale (SPTS) and is a named consultant on the Sheehan-Suicidality Tracking Scale (S-STS), the Sheehan- Suicidality Tracking Scale Clinically Meaningful Change Measure Version (S- STS CMCM), the Pediatric versions of the S-STS, and the Suicidality Modifiers Scale; Dr. D. Sheehan is the author and copyright holder of the S-STS, the S-STS CMCM, the Pediatric versions of the S-STS, the Sheehan Disability Scale (SDS), and the Suicidality Modifiers Scale, is a co-author of the SPTS, and owns stock in Medical Outcomes Systems, which has computerized the S-STS. ADDRESS CORRESPONDENCE TO: David V. Sheehan, MD, MBA; E-mail: KEY WORDS: Suicide scale, suicide assessment, suicide risk, suicide, suicidality, S-STS, SPTS, time spent, global severity, hopelessness [ C A S E S T U D Y ] The Complexity of Assessing Overall Severity of Suicidality: A Case Study

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