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 ] 38 tended to be closer to the original S- STS clinician-rated scale, but this was not consistently so across all categories. Agreement between S-STS and ISST-Plus. Figure 8 shows the agreement for the comparison between the clinician-rated versions of the ISST-Plus and the S-STS on the FDA-CASA 2012 categories (blue columns) for which data could be collected. Raw concordance was 80 percent or higher for all of the categories. This concordance was surprising since the two scales were developed independently, have very different source origins, and at face inspection appear different from each other in approach, lines of questioning, and format used to elicit information. Agreement between the S-STS patient-rated, clinician-rated, and t he reconciled scale versions. The results shown in Table 4 and Figures 3 to 7 suggest that the patient-rated version of the S-STS performed similarly to the clinician-rated S-STS with a few exceptions. The frequencies of "Active suicidal ideation: method, intent and plan" (#5) and of "Preparatory acts" (#10) were also somewhat higher on the patient-rated version (24 subjects vs. 18 and 10 vs. 6, respectively). Almost twice as many subjects (17 vs. 8) endorsed "Self-Injurious Behavior Without Suicidal Intent" (#11) on the patient-rated version compared to the clinician-rated version. Since some patients who had suicidal ideation in the past week may have engaged in non-suicidal self injury (e.g., to masochistically relieve tension) and this injury may have led to their emergency room visit, it cannot be concluded that the clinician made the correct assessment and that the patient was hiding the truth. In other words, the discrepancy between ratings of the patient and clinician on this item can be interpreted in opposite ways. Both may have been correct some of the time. This finding lends support to the idea that the patient-rated S-STS may not be any less valid an approach than the clinician-rated S-STS (or even the "reconciled") version of the S-STS. This finding needs to be replicated in much larger samples and in different clinical and cultural settings. Suicidality combinations captured by ISST-Plus and S-STS but not by the C-SSRS. Sixty- seven percent of the patients had combinations of suicidal ideation phenomena (ideation, method, intent, plan) that did not fit any of the existing FDA-CASA 2012 or C– SSRS categories. As described in greater detail in two other articles, 7,8 the FDA-CASA 2012 and the C–SSRS only cover five of the 16 possible combinations of active ideation, method, intent, and plan and only six of 32 possible combinations of passive suicidal ideation, active s uicidal ideation, method, intent, and plan. In contrast, the S-STS and the ISST-Plus both capture all these possible combinations. Tables 5 and 6 display the combinations captured by the S-STS, but not captured by the C–SSRS, and the combinations captured by both. Table 5 displays the data using the clinician-rated S-STS for all 45 suicidal and non-suicidal patients while Table 6 shows the data using the patient-rated S-STS for only those 40 patients who had SIB. Among the 45 suicidal and non- suicidal patients, 67 percent had combinations of suicidal ideation, method, intent, or plan detected by the clinician-rated S-STS, and 76 percent had combinations detected by the clinician-rated ISST-Plus, for which no unique combination category exists on the C–SSRS. Among the 40 suicidal subjects, 80 percent had combinations of suicidal ideation, method, intent, or plan detected by the patient-rated S-STS, for which no unique combination category exists on the C–SSRS. Examples include the combination of active ideation, with intent, but with no method or plan. Duration of interviews. The computer clock tracked the duration of the ISST-Plus, S-STS patient- rated, S-STS clinician-rated, and the S-STS reconciled version. The taped videos were used to calculate the duration of the C–SSRS (since the C–SSRS was only done on paper). Table 7 shows the duration of the 34 interviews (out of a total of 45) for which there was comparable data across all three scales and their variants. Videos were not done for five study participants, an additional two were unable to complete the patient-rated version because of injuries, one was unable to complete the reconciliation because of the subject's emotional state, and three of the remaining 37 participants (8.1%) did not need a reconciliation TABLE 3. Suicide severity in subjects (N=45) SEVERITY OF SUICIDAL IDEATION AND BEHAVIORS (CGI-SS) SUBJECTS N (%) Not suicidal, recent a ccident 5 (11.1) Not suicidal, but self-harm (on the border of being suicidal) 7 (15.6) Questionably suicidal 5 (11.1) Mildly suicidal 6 (13.3) Moderately suicidal 6 (13.3) Severely suicidal 5 (11.1) Extremely suicidal 6 (13.3) Recently attempted suicide 5 (11.1) CGI-SS: Clinical Global Impression Scale for Severity of Suicidality

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