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 ] 36 with Figures 3 to 7, show the results of the tests of agreement between the ISST-Plus and the C–SSRS and the three versions of the S-STS for each FDA category with the exception of completed suicide (#6) for which no subjects met criteria. The five subjects who had been involved in a recent accident are not included in these results for two reasons. First, their injuries were such that they could not complete the patient-rated version of the S- STS. Second, none had any suicidality and the C–SSRS does not capture this category. The C–SSRS was not designed to categorize such subjects, and thus cannot be used as a standard reference for them. On the ISST-Plus and S-STS, these five subjects mapped to category 15 (other injury or overdose, no suicide intent). Agreement between the ISST- Plus and C–SSRS. AUC values were good to excellent (0.80–1.00) for "Passive ideation" (category #1), "Suicidal attempt" (#7), and "Preparatory acts" (#10). The AUC was acceptable (0.70–0.80) for "Active suicidal ideation: method, intent, and plan" (#5) and "Self- Injurious Behavior Without Suicidal Intent" (#11). AUC values were poor (<0.70) for categories "Active suicidal ideation: nonspecific" (#2), "Active suicidal ideation: method, but no intent or plan" (#3), "Active suicidal ideation: method and intent, but no plan" (#4), "Interrupted suicide attempt (#8), and "Aborted suicide attempt" (#9). TABLE 1. Mapping algorithms (How the ISST-Plus, S-STS, and C–SSRS map to FDA-CASA 2012) FDA-CASA 2 012 CODE N UMBER F DA-CASA 2012 CLASSIFICATION I SST-PLUS MAP TO FDA-CASA 2012* S -STS MAP TO FDA-CASA 2012 C -SSRS MAP TO FDA-CASA 2012 1 "Passive suicidal ideation" Y es if: Part I, Item 1≥1 A positive response to 2 A "yes" response to item 1 : "Wish to be Dead" 2 " Active suicidal ideation: nonspecific ( no method, intent, or plan)" Yes if: (Part I, Item 4≥1 OR Part I, Item 5 ≥1) AND Part I Items 10, 11, 12=0 A positive response to 3 AND a n egative response to 4, 5, 6, and 7 A "yes" response to item 2: 'Non- s pecific Active Suicidal Thoughts" 3 " Active suicidal ideation: method, but no intent or plan" Y es if: (Part I, Item 4≥1 OR Part I, Item 5 ≥1) AND Part I, Item 10≥1; AND Part I, Items 11, 12=0 A positive response to 3 and 4 AND a negative response to 5, 6, and 7 A "yes" response to item 3: "Active S uicidal Ideation With Any Methods ( no plan) Without Intent to Act" 4 "Active suicidal ideation: method and intent, but no plan" Yes if: (Part I, Item 4≥1 OR Part I, Item 5 ≥1) AND Items 10 and 12≥1; AND I tem 11=0 A positive response to 3 and 4 and (6 or 7) and a negative response to 5 A "yes" response to Item 4: "Active S uicidal Ideation With Some Intent to Act, Without Specific Plan" 5 " Active suicidal ideation: method, i ntent, and plan" Yes if: (Part I, Item 4≥1 OR Part I, Item 5 ≥1) AND Part I, Items 10, 11, and 12≥1 A positive response to 3, 4, and 5 and ( 6 or 7) A "yes" response to item 5: "Active Suicidal Ideation With Specific Plan a nd Intent" 6 "Completed suicide" Yes if: Part III coded as 6 A "yes" response to 13 NA 7 "Suicide attempt" Yes if: "Yes" on Part II, Item 1.2 OR " yes" on Part II, Item 1.3 A positive response to 10 or 16 OR a " yes" response to 1b A "yes" response to "Actual Attempt" 8 "Interrupted suicide attempt" Yes if: Part II, Item 2.3≥1 A positive response to 8 with at least one Level 3 on 12 A "yes" response to "Interrupted Attempt" 9 "Aborted suicide attempt" Yes if: Part II, Item 2.2≥1 A positive response to 8 with at least o ne Level 2 on 12 A "yes" response to "Aborted Attempt" 10 "Preparatory acts toward imminent suicidal behavior"—"not counting aborted or interrupted attempts" Yes if: Part II, Item 1.4=Yes A positive response to 8 with at least one Level 1 on 12 A "yes" response to "Preparatory Acts or Behavior" 11 "Self-Injurious Behavior Without Suicidal Intent" Yes if: Part II, Item 1.1=Yes; AND Part II, Item 1.2=No A positive response to 9 OR a positive response to 1a and a negative response to 1b A "yes" response to "Has subject engaged in Non-Suicidal Self-Injurious Behavior?" 12 "Self-injurious behavior, intent unknown" Yes if: Part II, Item 1.1=Yes; AND Part II, Item 1.2=unknown/NA A positive response to 1a with 1b and 6 and 7 and 10 unanswered NA 13 "Not enough information (fatal)" Yes if: Part III scored 8 A "yes" response to 14 NA 14 "Not enough information (nonfatal)" Yes if: Part II, Item 1.0=Unknown/NA OR Part II, Item 1.1=Unknown/NA Yes if question 17 is "yes" and FDA- CASA 2012 code numbers 1–13 are ALL "no" NA 15 "Other (accidental, psychiatric medical), no deliberate self-harm" Yes if: Part II, Item 1.0=Yes AND Part II, Item 1.1=No (A positive or blank response to 1 and a negative response to questions 2, 3, 4, 5, 6, 7, 8, 9, 10, 13, and 14) OR a positive response to 15 NA *For each separate event, only the most severe categorization was counted. All separate events were assessed. ISST-Plus: InterSePT Scale for Suicidal Thinking-Plus; S-STS: Sheehan-Suicidality Tracking Scale; C–SSRS: Columbia–Suicide Severity Rating Scale; FDA-CASA 2012: United States Food and Drug Administration-Classification Algorithm of Suicide Assessment; NA: not applicable

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