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 25 assessments initiated since September 2009. Incomplete eC- SSRS assessments, records created during system testing, and records f rom four studies with 10 or fewer completed assessments were excluded from further consideration, yielding a dataset of 74,406 records (99.4% of all extracted records). A previous publication that examined the ability of summary eC- SSRS scores to predict future ideation and behavior included 35,224 (47%) of these records. They are also included here, as the goals of this study are different from the initial study: the focus in this paper is on the prediction of future ideation and behavior by individual eC-SSRS items, rather than the summary scores, and both psychiatric and nonpsychiatric samples are evaluated. 2 0 Of the remaining 74,406 eC-SSRS assessments, 5,299 were baseline assessments not associated with subsequent prospective monitoring of SIB and 14,651 records were from prospective monitoring of SIB not associated with a prior baseline assessment of lifetime SIB. These records were also excluded from further analyses since they provide no information regarding predictive associations between baseline assessment of lifetime SIB and subsequent risk of prospectively reporting suicidal behavior during research participation. The remaining 54,456 eC-SSRS assessment records (41% of these records were included in the 2013 publication) were retained for analysis using SPSS (V 20; IBM Corporation, Armonk, New York). Each record linked to a unique patient ID, study ID, treatment indication, assessment type (baseline of lifetime SIB or prospective assessment since last contact), date, and patient responses to the eC-SSRS queries. No patient demographic, treatment blind, or personally identifying information was available in the anonymized, pooled dataset. The final dataset included 8,837 unique patients. Studies were classified as representing psychiatric or nonpsychiatric patients based on the treatment indication of the study. T reatment indications of opioid dependence, generalized anxiety disorder, major depressive disorder, and posttraumatic stress disorder were categorized as psychiatric studies; nonpsychiatric treatment indications included chronic obstructive pulmonary disease, epilepsy, fibromyalgia, human immunodeficiency virus, insomnia, multiple sclerosis, osteoarthritis, pain/back pain, Parkinson's disease, and restless leg syndrome. Baseline eC-SSRS assessments were used to characterize each patient with respect to the greatest lifetime suicidal ideation severity and prior experiences of suicidal behaviors (e.g., actual, interrupted, and/or aborted suicide attempts or behavior preparatory to an attempt). Each patient was characterized as lifetime SIB status of 1) no lifetime suicidal ideation with intent to act and no prior suicidal behavior (i.e., "None"); 2) prior suicidal ideation with intent to act, but no suicidal behavior (i.e., "Ideation only"); 3) no prior suicidal ideation with intent to act, but reported prior suicidal behavior (i.e., "Behavior only"); or 4) both suicidal ideation with intent to act and previous suicidal behavior (i.e., "Both"). Prospective eC-SSRS reports of SIB during study participation were also used to classify each patient's suicidal ideation and behavior as "Negative" or "Positive." These assessments were completed at each study visit, and raters asked patients about ideation and behavior since the last assessment. Therefore, the assessed time frame does not overlap with the lifetime assessment. Patients who prospectively reported active ideation with a method and intent to act (with or without a specific plan) at any visit were categorized as "Positive" for suicidal ideation. Patients reporting any suicidal behavior during study participation, at any visit, were classified as "Positive" for suicidal behavior. Relative risk of prospectively reporting suicidal ideation and b ehavior during study participation among patients reporting lifetime SIB of "Ideation only," "Behavior only," or "Both" was computed using Mantel- Haenszel methods; the lifetime SIB group of "None" served as the reference risk group. An analysis predicting future behavior was also conducted by Mundt et al. in 2013 2 0 using a subset (47%) of the data included in the current analysis. Analyses using only data that were not included in the earlier paper 20 replicated results from analyses of the full dataset and are not presented here. More detailed analyses of prospective risk associated with each level of baseline suicidal ideation severity (e.g., "Passive ideation," "Active ideation without method," "Active ideation with method but no intent," "Active ideation with method and intent but no plan," "Active ideation with method, intent, and plan") as well as risks associated with baseline reports of individual and multiple lifetime behaviors were also evaluated. RESULTS Of the 54,456 eC-SSRS assessments analyzed, 8,837 were baseline and 45,619 were prospective follow-up assessments. Of the 8,837 baseline assessments of lifetime SIB, 6,760 were from patients participating in psychiatric studies and 2,077 were from patients participating in nonpsychiatric studies. On average, patients participating in psychiatric studies had more prospective follow-up visits (mean [M]=5.63; standard deviation [SD]=2.85) than patients in nonpsychiatric studies (M=3.63; SD=2.34; t(8,835)=29.18, p<0.001); however, the follow-up period from baseline to final follow-up assessment tended to be shorter for psychiatric studies (M=72.33; SD=67.03 days) than for nonpsychiatric studies (M=97.81; SD=89.07 days; t(8,835)= -13.95, p<0.001).

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