Innovations In Clinical Neuroscience

SEP-OCT 2014

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

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Page 169 of 201

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 ] 170 Discussion. At the high end of the hopelessness score, there was a disproportionately lower score on the SPTS total. When the hopelessness was very high, the patient engaged in more preparatory behaviors, which resulted in less suicidal planning (and, hence, the disproportionately lower SPTS scores). Result 11: Correlation matrix. Table 2 shows a correlation matrix between all of the variables discussed in this case study. Discussion. There were strong correlations among most of the variables examined in this case study. The weaker relationship between the global severity of suicidality and both the S-STS total score and the SPTS total score may relate to the daily collection of the global severity ratings and ratings that were summed for the week, while the scale scores were collected weekly using a look- back over the week. Another reason may relate to a tendency for the subject to minimize the global severity of suicidality ratings compared to her perception that she more accurately reported the item scores on each of these two scales when the rating was done weekly. The otherwise strong correlations make clinical sense in the light of the interpretations reported for Results 1 through 10 above. DISCUSSION Relying on only one or two metrics to assess global severity of suicidality appears to have significant limitations. Patients with suicidality and experienced clinicians instinctively understand this. The subject of this report succinctly summarized this issue and its implications to us when she stated "if a clinician believes they can assess my suicidality based only on one question (which actually happened to me), as in a global severity of suicidality rating, then it is clear to me that they do not understand suicidality well enough to properly treat me. I interpret a clinician's use of one question to assess my suicidality to mean it's a waste of my time to be honest with them and end up being admitted to the hospital under their care." Clinicians may find that they are better able to engage their suicidal patients in an empathic therapeutic relationship if they take the time to conduct their assessments of suicidality using a multidimensional approach. Limitations. The limitations of this study are that it is based on a single case, the case may be an outlier, and the findings may not be generalizable to other cases of suicidality. Another possible limitation is that the global severity ratings were collected daily and summed for the week, while the other variables were collected weekly. The subject's personal understanding of suicidality and its severity is likely normalized using herself as a reference. This could limit the meaningfulness of the findings. On the S-STS (11/11/11 version used), the suicidality score can range from 0 to 44. Over the 65- week period of this case study, the subject's S-STS score ranged from 12 to 31 (maximum possible is 44), from 27 to 64 on the SPTS (maximum possible is 76), and from 7 to 25 on the global severity of suicidality scale (maximum possible is 28), which covers a wide range of severity. A single case study covering the phenomena of suicidality across 31,183 suicidal events tracked over 65 weeks may have some advantages over data collected in a larger series by providing more consistency of T A B L E 2. C o r r e l a t i o n m a t r i x o f t h e S - S T S t o t a l , g l o b a l s e v e r i t y o f s u i c i d a l i t y, t i m e s p e n t i n s u i c i d a l i t y, H o p e l e s s n e s s S p e c t r u m , a n d S P T S t o t a l A S S E S S M E N T M E A S U R E S - S T S T O TA L G L O B A L S E V E R I T Y O F S U I C I D A L I T Y T I M E S P E N T I N S U I C I D A L I T Y H O P E L E S S N E S S S P E C T R U M S P T S T O TA L S - S T S T O TA L 1 - - - - - - - - G L O B A L S E V E R I T Y O F S U I C I D A L I T Y 0 . 3 8 9 6 6 3 7 1 - - - - - - T I M E S P E N T I N S U I C I D A L I T Y 0 . 5 6 0 6 3 3 7 0 . 7 2 7 3 2 7 4 1 5 1 - - - - H O P E L E S S N E S S S P E C T R U M 0 . 6 3 0 9 9 6 0 . 5 5 6 7 2 1 0 0 8 0 . 6 4 6 0 8 3 0 9 5 1 - - S P T S T O TA L 0 . 7 5 8 5 9 4 9 0 . 4 9 8 0 6 3 7 7 4 0 . 7 1 0 1 7 7 9 7 8 0 . 7 0 9 2 7 5 9 8 4 1 S - S T S : S h e e h a n - S u i c i d a l i t y Tr a c k i n g S c a l e ; S P T S : S u i c i d e P l a n Tr a c k i n g S c a l e

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