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 193 questions only deviated by a mean of 1 point of seriousness. On the SM, the mean deviation of any question, when any deviation o ccurred on the question, was only 1 point of seriousness. On the IH Questions, there was no deviation at all. Overall, there was deviation on five percent of all scale questions across all timeframes (35 out of a total of 744 questions). The deviation in note topics mainly related to the subject's current severity of suicidality symptoms (4 out of 24 timeframes). Comparison of self-version (days later) to self-version (for therapist). For the purpose of this comparison, the self-version (days later) is used the standard against which the self-version (for therapist) was judged. On the S-STS, there were deviations in the counts of passive and active suicidal ideation and the count of non-suicidal self-injury (occurring in 18, 21, and 12 timeframes, respectively). There were also deviations in the severity and type of suicidal planning, which occurred in at least 18 of the 24 timeframes. The seriousness of preparatory behaviors deviated an aggregate total of 25 points during only six timeframes. On the SM, the deviations occurred in all of the hopelessness questions during all 24 interviews. On the IH Questions, there was no deviation at all in the usual caution/impulsivity question and only minimal deviation in the usual hopefulness/hopelessness question. Overall, there was deviation on 45 percent of all scale questions across all 24 timeframes (337 out of a total of 744 questions). The subject did not report some of the note topics that were included in self-version (days later) to the therapist that related to the severity of her symptoms, to details about planning an attempt (including possible dates), and that were directly related to the therapist. These deviations occurred in eight, 10, and three timeframes, respectively. DISCUSSION This case study illustrates the potential for important information to be missed if a patient is only asked to r ate a suicidality scale once for a specific timeframe. It is possible that some suicidal phenomena occur too close to the timeframe in question for a patient to immediately acknowledge the presence, the gravity, or the details associated with those phenomena. Coping often involves acutely minimizing the gravity of the symptoms. In settings where suicidality rating scales are regularly used, it may be helpful for a clinician to routinely ask the patient if there were any details about the patient's suicidality during earlier timeframes that were not previously shared with the clinician. Doing so may serve as a way for the clinician to gather information that is still clinically relevant and that occurred during a prior timeframe but was not previously reported. Our findings do not support the common assumption that the near- term suicidality scores about the same timeframe decrease as time passes. 1 Indeed, in this individual case, we found that opposite occurred. There were deviations in five percent of all questions between the self-version (immediate) to the self- version (days later). The total deviations on all questions between the self-version (immediate) and the self-version (for therapist) were much higher at 41 percent of all questions. This suggests it was easier for the subject to be honest with herself than it was for her to be honest with her therapist. Limitations. The use of only one subject for this case study means these findings may not be generalizable to other cases of suicidality. Knowing that the collected data would be given to someone else may have biased the subject's reporting of events. CONCLUSION This case study illustrates that a subject's reporting of symptoms of suicidality using a patient-rated scale can vary depending upon the context, distance from timeframe in question, and the subject's relationship with the clinician, rater, or reviewer of the data. It is possible similar issues relate to clinician-rated suicidality scales. REFERENCES 1. Sundin EC, Horowitz MJ. Horowitz's Impact of Event Scale evaluation of 20 years of use. Psychosomat Med. 2003;65(5):870–876. 2. Sheehan DV, Alphs L, Mao L, et al Comparative validation of the S-STS, the ISST-Plus, and the C-SSRS for assessing the suicidal thinking and behavior FDA 2012 suicidality categories. Innov Clin Neurosci. 2014;11(9–10):32–46. 3. Alphs L (personal communication). Suicidality Modifiers (SM) were developed by Sheehan DV, Alphs L, and Giddens JM for the study "Comparative validation of the ISST- Plus, the S-STS, and the C-SSRS for assessing suicidal thinking and behavior," which was presented as a poster presentation at the 14th International Congress on Schizophrenia Research (ICOSR). Orlando, FL: April 21–25, 2013. 4. Alphs L (personal communication). Two dichotomized spectrum test questions (one assessing impulsivity/caution dichotomous spectrum, the second using a hopefulness/hopelessness dichotomous spectrum) were developed for "Comparative validation of the ISST-Plus, the S- STS, and the C-SSRS for assessing suicidal thinking and behavior," which was presented as a poster presentation at the 14th International Congress on Schizophrenia Research (ICOSR). Orlando, FL: April 21–25, 2013. 5. Dolphin Electronic Data Capture (eMINI Professional Version 2.1.1 / R131112.1 Database Version 2.26) [Software]. (1994–2012). http://medical-outcomes.com.

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