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 73 TABLE 2. Mismatches in probes, definitions, and titles in C–SSRS C ategories Title and Definition Match Title and Probe Match Definition and Probe Match Title, Definition, and Probe Match SUICIDAL IDEATION "Wish to be Dead" Yes Yes No 1 No 1 "Non-Specific Active Suicidal Thoughts" No 2 No 2 No 2 No 2 "Active Suicidal Ideation with Any Methods (Not Plan) Without Intent to Act" No No 3 No 3 No 3 "Active Suicidal Ideation With Some Intent to Act, Without Specific Plan" No 4 No 4 No No 4 "Active Suicidal Ideation with Specific Plan and Intent" Yes No 5 No No 5 SUICIDAL BEHAVIOR "Actual Attempt" No 6 No No 6 No 6 "Interrupted Attempt" Yes Yes Yes Yes "Aborted Attempt" Yes Yes Yes Yes "Preparatory Acts or Behavior" No 7 Yes No 7 No 7 "Suicide" No definition 8 Yes No definition 8 No definition 8 "Non-Suicidal Self-Injurious Behavior" No definition No probe N/A N/A 1 Probe narrows the definition by not including a wish to be "not alive anymore."* 2 Definition expands the title by specifying no method, intent or plan. Probe expands the title by not clarifying that thoughts need to be non-specific. Probe expands the definition by not excluding thoughts associated with method, intent or plan.* 3 Probe expands title and definition by not specifying that thoughts need to be active or non-specific. Probe further expands or narrows title and definition depending on how rater interprets "this" in "How have you being thinking about how you might do this?"* 4 Definition expands the title by not clarifying that the category is precluded if there is a specific plan. Probe similarly expands the title by not specifying that this category cannot be endorsed if there is a plan.* 5 Definition expands the title by not specifying that thoughts need to be active (cannot be passive). Probe expands the title by not specifying that plan and intent need to be accompanied by active ideation.* 6 Definition limits the range of suicide attempts captured. For example, a child eats an apple her brother tells her has been poisoned and will kill her if she eats it. She has intent to die and eats the apple. But there is nothing wrong with the apple and he is teasing her. She believes him. This should be classified as a suicide attempt even though eating a harmless apple has no "potential for injury or harm" as the definition requires.* 7 Definition narrows the title by indicating that preparatory acts or behavior need to be "imminent." Probe, however, expands the definition by not making this requirement.* 8 This category is tucked into a probe under "Suicidal Behavior." The probe matches the title but there is no definition beyond what is in the probe.* NOTE: The 3 authors disagreed among themselves on several of the decisions in this table. The authors also had different interpretations of these mismatches at different points in time. Others disagreed with these decisions, reflecting very poor inter-rater reliability on these points. * Posner K, Brown GK, Stanley B, et.al. The Columbia–Suicide Severity Rating Scale: initial validity and internal consistency findings from three multisite studies with adolescents and adults. Am J Psychiatry. 2011;168:1266–1277. C–SSRS: Columbia–Suicide Severity Rating Scale

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