A peer-reviewed, evidence-based journal for clinicians in the field of neuroscience
Issue link: http://innovationscns.epubxp.com/i/425963
[ 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 49 METHODS Participants. A convenience sample of 45 subjects with varying severity of SIB were recruited from i npatient and outpatient psychiatric settings associated with the University of Alabama at Birmingham (UAB), a medium-sized medical school in the southeastern United States. We sought a minimum of five subjects from each of eight levels of SIB severity (described in "Measures" below). The Institutional Review Board of UAB approved the study, and each subject gave written informed consent. Measures. This study was conducted within the context of a comparison of the InterSePT Scale for Suicidal Thinking–Plus (ISST–Plus), 38 the Sheehan-Suicidality Tracking Scale (S-STS), 39 and the Columbia–Suicide Severity Rating Scale (C–SSRS). 2 This comparison sought to determine the extent to which these scales could be used to map to the United States Food and Drug Administration's (FDA) Classification Algorithm for Suicide Assessment (CASA). 40 A complete description of the methodology used for this comparison is being prepared in another report. 4 1 The data in this paper includes the computerized 11/11/11 versions of the S-STS, the Suicidality Modifiers (SM) scale (used in University of Alabama Birmingham S-STS validation study 42 ), and the Alphs Dichotomous Impulsivity and Hopelessness (IH) (2 questions) from the ISST-Plus (used in the University of Alabama Birmingham ISST-Plus Validation Study). The S-STS is a well-validated instrument to assess SIB. 39,41,43 The S-STS obtains parallel scores from the patient as well as from the clinician, the latter based on structured clinical interview. We were unable to collect S-STS patient ratings from subjects who presented with accidental injuries, as these all involved upper extremity injuries that precluded their ability to respond using the instrument's computer interface. Consequently, we used the "Suicidal ideation" score from the clinician-rated S-STS as our metric for current suicidal ideation, as this provided us data across the entire range of suicidal ideation presenting in our sample. Higher scores indicated m ore intense suicidal ideation. Patients also responded to questions regarding their feelings of hopelessness and impulsivity. "Stable" questions were framed in the context of "day-to-day life," whereas "recent" were framed within the context of the past seven days. The questions were as follows: 1. Recent hopelessness (rated on a 5- point scale from "Not at all"  to "Extremely" ): 1) How much did you lose hope that your life would get better? and 2) How difficult was it for you to be hopeful that your life would get better? 2. Trait hopelessness (rated on a 7- point scale ranging from "Extremely hopeless"  to "Extremely hopeful" ): How hopeful/hopeless are you in your day-to-day life? 3. Recent impulsivity reflecting attacks of impulsive suicidality (same 5-point scale as the "Recent hopelessness" items): 1) How strong was the impulse (urgent need) to plan or to act in any suicidal way? and 2) How difficult was it for you to suppress or to restrain the impulse to plan or to act in any suicidal way? 4. Trait impulsivity (rated on a 7- point scale ranging from "Extremely cautious"  to "Extremely impulsive ): How impulsive/cautious are you in your day-to-day life? As with the S-STS, responses to these questions were provided directly by patients via computer interface or to a clinician within an interview format. In the latter context, the clinician provided the rating felt to be the most accurate. For the "recent" items, we used the sum of the ratings for the two questions for each of the two domains (hopelessness and impulsivity). Raters. Five raters were trained to administer all three scales and the pilot scale. Three of the five raters were master's level counselors and two had Bachelor of Science degrees with extensive clinical research experience. Each was selected to a dminister a scale to a given subject on an "as available" basis. The raters participating in this study were qualified mental health professionals with experience working with suicidal patients. They were trained and certified using the training materials developed for each assessment scale. These included use of semi-structured interviews developed for each of the three SIB assessment instruments (C-SSRS, ISST-Plus, and S-STS). Similar standardized definitions of all critical SIB terms were used for all three scales. The authors of the respective instruments supervised the training the training for each scale. Statistical analysis. All analyses were performed using Stata 13.1 (StataCorp, 2013 Stata: Release 13. Statistical Software. College Station, Texas: StataCorp LP). Baseline demographics and clinical characteristics were evaluated using descriptive statistics. Our first two hypotheses addressed the strength of the correlation between continuous variables: these were tested comparing the respective Spearman's rhos using Hotelling's t. Our second two hypotheses involved group differences: these were examined with traditional t-tests. RESULTS Study subjects. Demographics are summarized in Table 1. Most subjects were female (55.6%); 73.3 percent were white, 24.4 percent were black, and 2.2 percent were of mixed race. The number of subjects at each level of SIB severity is depicted in Table 2. Although only five out of 45 of our subjects had recently attempted suicide, the majority of the patients with suicidal ideation had attempted suicide in the past. In fact, of the 34 subjects reporting suicidal ideation who had not made a recent attempt, 25 of these subjects (74%) had a history of at least one previous suicide attempt.