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 165 relationship across the full range of symptoms. However, the relationship between symptom scale scores and global assessments of severity is often c omplex. This case study investigates the relationship between total scores and other measures sometimes used to assess global severity of suicidality. The findings may assist clinicians and regulators in how best to judge the overall severity of suicidality. Can this be accomplished with one metric or is it necessary to judge global severity of suicidality in a multidimensional fashion? The case study attempts to shed some light on this question. METHODS A 29-year-old female subject diagnosed with Asperger syndrome who experienced suicidality almost daily for more than 20 years collected detailed daily and weekly data on her events of suicidality. She rated the severity of her suicidality daily using a 0 to 4 global severity scale, where 0=not at all, 1=mild, 2=moderate, 3=severe, and 4=extreme. Suicidality was defined as the suicidal phenomena captured by page 1 of the 11/11/11 version of the Sheehan-Suicidality Tracking Scale (S-STS), 3 with the exception of non-suicidal self-injury. Suicidality is broader than the term suicidal ideation and behavior. It encompasses suicidal impulses, which can occur before and apart from suicidal ideation, and includes other suicidal phenomena such as suicidal dreams and psychotic command hallucinations to take suicidal actions. The term global suicidality embraces all of these phenomena in one global score. The subject captured these daily scores every morning for the prior day (12:00 AM through 11:59 PM) in a spreadsheet. The subject completed the computerized version of the 11/11/11 version of the S-STS each week. 4 The S-STS is a two-page scale with 11 questions about suicidal phenomena and one question on non-suicidal self- injury that uses a 0 to 4 (5-point) Likert scale with descriptive anchors (0=not at all, 1=a little, 2=moderately, 3=very, 4=extremely). She completed the Suicide Plan Tracking Scale (SPTS) each week. The SPTS is a 20- q uestion scale about suicidal planning that uses a 0 to 4 (5-point) Likert scale with two sets of descriptive anchors. Seventeen questions use 0=not at all, 1=a little, 2=partially, 3=mostly, and 4=totally as descriptive anchors; two questions use 0=none, 1=a little, 2=partial, 3=a lot, and 4=complete as descriptive anchors; and one question has a no/yes response option. The subject also completed the Alphs Dichotomous Hopeful/Hopelessness Question (Hopelessness Spectrum) (used in the University of Alabama Birmingham InterSePT Scale for Suicidal Thinking [ISST-Plus] Validation Study 5 ) each week. The Hopelessness Spectrum descriptive anchors were "extremely hopeful," "very hopeful," "moderately hopeful," "in the middle," "moderately hopeless," "very hopeless," and "extremely hopeless." The subject completed this weekly tracking on Mondays for the prior week (Monday at midnight to Sunday night at 11:59:59 PM). The subject concurrently documented her global severity of suicidality events for the prior day every morning over 65 weeks and the time spent daily in suicidality for 56 of these weeks. During the 65 weeks, she documented 31,183 separate suicidality events. We summed the daily 0 to 4 global severity scores for each week of tracking. The total S-STS score was calculated by summing the scores to answers 1 through 8 and 10. Question 9 (non-suicidal self-injury) was not counted as a suicidal phenomenon and was excluded from the total S-STS score calculation. The most recent version of the S-STS (1/4/14) does not include the non- suicidal self-injury item in the calculation of the total S-STS score, consistent with the way the total S- STS score is calculated in this paper. The SPTS score was calculated by summing the scores to answers 1 through 19. The answers to the Hopelessness Spectrum were converted to numeric values with 1=extremely hopeful, 2=very h opeful, 3=moderately hopeful, 4=in the middle, 5=moderately hopeless, 6=very hopeless, and 7=extremely hopeless. The daily number of minutes the subject experienced suicidality each week were summed. Table 1 illustrates the way this case study reports the relationship of the variables to each other. The result number listed in the table indicates which section of the paper discusses each of these relationships. Data for the S-STS total, the global severity of suicidality, the Hopelessness Spectrum, and the SPTS total were collected for 16 months, but data for the daily time spent experiencing suicidality were only collected for the last 13 months (56 weeks) of that 16-month (65 weeks) period. All available data were used in the analysis for this paper. RESULTS Result 1: S-STS total and global severity of suicidality. Figure 1 illustrates the relationship between the S-STS total score and the global severity of suicidality. There is an ascending relationship between the S-STS total and global severity of suicidality. A polynomial regression trendline is the best fit to the dataset: Figure 1 shows an order 2 trendline. Discussion. As the S-STS total score increased, the global severity score decreased at the top end. The subject interpreted this to mean that when the S-STS scores where high, she somewhat minimized the overall global severity of suicidality. She believes she did this in order to help her cope with the severity of her symptoms. She stated that it was easier to admit to the severity of one item on the S-STS (even if this occurred multiple times and the item scores were then summed, as in the S-STS) than it was to admit to the gravity of the overall global severity of suicidality. 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 ]

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