Innovations In Clinical Neuroscience

SEP-OCT 2014

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

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[ 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 ] Innovations in CLINICAL NEUROSCIENCE 167 subject believes that the main driver of the global severity at the lower end of the trendline was the time spent in suicidality. However, toward t he middle and the top end of the trendline, the driver may flip-flop between both the time spent and the global severity. The subject noted that when her symptoms were more severe there was an increase in time spent, which increased the global severity. These increases compounded each other leading to a deteriorating spiral, until it was difficult to determine which one was the primary driver. In a 0 to 4 global severity scale, when the score exceeds 2, the time spent appears to be a more sensitive measure of global severity than the global severity rating itself. Time spent in suicidality is a very sensitive signal of severity of suicidality, especially at the upper end of suicidality severity. Result 4: S-STS total and Hopelessness Spectrum. Figure 4 illustrates the relationship between the S-STS total score and the Hopelessness Spectrum. There is an ascending relationship between the S-STS total and the Hopelessness Spectrum. A polynomial regression trendline is the best fit to the dataset: Figure 4 shows an order 2 trendline. Discussion. At the high end of the S-STS total score, the hopelessness score became disproportionately higher. The subject noted that when her S-STS total score was higher (i.e., when she was actively planning a suicide attempt), it tended to be at times when her hopelessness was more extreme. The S-STS score might reach a plateau where it cannot get any higher until the patient makes an attempt. The subject noted that this might explain why the hopelessness score became disproportionately higher than the S-STS score. She stated that she tended not to begin engaging in preparatory behaviors and/or willful suicidal planning unless her hopelessness was extreme. Twenty-eight points is the highest possible score the subject can get on the S-STS without engaging in a preparatory behavior or making an attempt. This score is reduced by 4 if the patient did not have an accident in the time frame. Thus, 24 points is about as high of a score as possible without the subject engaging in suicidal behaviors. Twenty-four points on the S-STS is approximately the location in the trendline where the hopelessness score became disproportionately higher. Result 5: Global severity of suicidality and Hopelessness Spectrum. Figure 5 illustrates the relationship between the global severity of suicidality and the Hopelessness Spectrum. There is an ascending relationship between the global severity of suicidality and the Hopelessness Spectrum. A polynomial regression trendline is the best fit to the dataset: Figure 5 shows an order 2 trendline. Discussion. At more severe levels of hopelessness (at a score of 6 or higher), the global severity of suicidality decreased disproportionately. The subject noted that this may relate to the way these two data values were captured. The global severity of suicidality score was rated daily and then summed for the week while the hopelessness rating was only captured once weekly. The subject stated that it was easier for her to be completely honest once on the hopelessness rating than it was for her to be honest seven times in the week on the global severity of suicidality rating. It is also likely the FIGURE 3. Global severity of suicidality and time spent in suicidality FIGURE 4. Sheehan-Suicidality Tracking Scale (S-STS) total and Hopelessness Spectrum

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