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 27 formats, can easily be merged with data from other studies and used to monitor the risks and/or benefits of different medications regarding SIB. Several limitations of these analyses should be noted. First, these data reflect lifetime assessment of SIB at baseline and do not address how recent or temporally distant the reported thoughts and events were from the prospectively reported behaviors. Nonetheless, these lifetime ideations and behaviors are clearly important factors influencing the risk of prospective suicidal behaviors. If anything, assessment of more recent ideation and behavior should increase the predictive value of the scale, due to its closer proximity to the follow-up assessments. A recent revision of the eC-SSRS now assesses the recency of SIB at baseline in addition to obtaining the lifetime data analyzed in this paper. Second, the analyses of prospectively reported SIB were strictly based on self-report to the eC-SSRS and were not necessarily confirmed by subsequent clinician follow-up. Ideally, validation would be accomplished through the comparison of the eC-SSRS to other measures. 13 However, the eC-SSRS measures completed at baseline and during the subsequent visits examined different periods of time and, therefore, provide supporting evidence for the lifetime risk TABLE 1. Prospective reports of SIB during study participation (negative or positive) based on study type (psychiatric or nonpsychiatric) and lifetime SIB assessed at baseline. BASELINE REPORTED LIFETIME SIB PSYCHIATRIC STUDY PARTICIPANTS NONPSYCHIATRIC STUDY PARTICIPANTS Prospective Behavior Prospective Behavior Negative Positive OR (95% CI)* Negative Positive OR (95% CI)* None 4,864 103 -- 1,976 7 -- Ideation Only 142 14 4.66 (2.6–8.3) *** 12 0 -- Behavior Only 769 92 5.65 (4.2–7.6) *** 45 2 12.55 (2.5–62.1) ** Both 648 128 9.33 (7.1–12.3) *** 33 2 17.11 (3.4–85.5) *** BASELINE REPORTED LIFETIME SIB Prospective Ideation Prospective Ideation Negative Positive OR (95% CI)* Negative Positive OR (95% CI)* None 4,934 33 -- 1,983 0 -- Ideation Only 140 16 17.09 (9.2–31.8)*** 12 0 -- Behavior Only 841 20 3.56 (2.0–6.2)*** 47 0 -- Both 730 46 9.42 (6.0–14.8)*** 35 0 -- * Within each participant category, patients reporting no lifetime suicidal ideation with an intention to act or any prior suicidal behaviors provide the reference group for computing the common odds ratio and confidence intervals. ** p<0.01 *** p<0.001 SIB: suicidal ideation and behavior

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