Innovations In Clinical Neuroscience

SEP-OCT 2014

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

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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 ] 182 by JENNIFER M. GIDDENS and DAVID V. SHEEHAN, MD, MBA J. Giddens is the 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):182–190 ABSTRACT Objective: The author of the widely used suicidality scale, the Columbia–Suicide Severity Rating Scale, has repeatedly made the claim that asking the question, "Do you think you would be better off dead?" in suicidality assessment delivers false positive results. This case study investigates the value of this question as an immediate antecedent to impulsive suicidality and as a correlate of functional impairment. Method: One subject with daily suicidality and frequent impulsive suicidality rated five passive suicidal ideation phenomena and impulsive suicidality daily on a 0 to 4 Likert scale and rated weekly functional impairment scores for 13 weeks on a 0 to 10 Discan metric. Results: Each of the five passive suicidal ideation phenomena studied frequently occurred at a different severity level, and the five phenomena did not move in synchrony. Most passive suicidal ideation phenomena were very low on dates of impulsive suicidality. Thoughts of being better off dead were a frequent antecedent to impulsive suicidality and were related to an increase in functional impairment. Conclusion: The relationship to both functional impairment and impulsive suicidality suggest that it is potentially dangerous to ignore thoughts of being better off dead in suicidality assessment. INTRODUCTION The value in asking the question, "Do you think you would be better off dead?" during a suicide assessment is a matter of controversy. Some scales 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: dsheehan@health.usf.edu KEY WORDS: Suicide scale, suicide assessment, suicide risk, suicide, suicidal ideation, impulsive suicide, impulsive suicidality, suicidality, C-SSRS, S-STS, better off dead [ C A S E S T U D Y ] I s Th e r e V a l u e i n A s k i n g t h e Q u e s t i o n " D o y o u t h i n k y o u w o u l d b e b e t t e r o f f d e a d ? " i n A s s e s s i n g S u i c i d a l i t y ? A C a s e S t u d y

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