Misclassification of Self-Directed Violence

Misclassification of Self-Directed Violence

Background: Classification of acts of self-directed violence has been shown to be inadequate in past research. Furthermore, level of expertise have been shown to be unrelated to classification correctness. Aim: The aim of the present study was to investigate whether participants provided with a definition are more reliable in their judgment than participants without a definition. Method: Two hundred sixty-one participants (psychology students, psychotherapists-in-training) were presented with case vignettes describing different acts of self-directed violence and were asked to make a classification. On the basis of randomized allocation, half of the participants received a definition of the different acts of self-directed violence, whereas the others did not. Results: Overall, 24.9% of the cases were misclassified. The presentation of a definition was not accompanied by a higher classification accuracy. Limitations: There may be issues about the validity of the case vignettes. Conclusions: The results highlight the importance of more methodological training of psychologists regarding suicidal issues.

Rural-Urban Comparisons in the Rates of Self-Harm, U.S., 2018

INTRODUCTION

This study compares rural and urban differences in the rates of nonfatal self-harm in the U.S. in 2018.

METHODS

Nationwide Emergency Department Sample and Census data were analyzed to calculate the RR of emergency department visits for self-harm between rural and urban residents. The analyses were conducted in 2021.

RESULTS

Among a weighted total of 488,000 emergency department visits for self-harm in the U.S., 80.5% were urban residents, and 18.3% were rural residents. In both settings, poisoning was the most common mechanism for self-harm, followed by cutting. Firearm-related self-harm and suffocation each accounted for <2% of total self-harm cases. Overall, the age-adjusted emergency department visit rate for self-harm was 252.3 per 100,000 for rural residents, which was 1.5 (95% CI=1.4, 1.6) times greater than the rate for urban residents (170.8 per 100,000 residents). The rates of self-harm among rural residents were higher than those of urban residents for both male and female residents, for all age groups except people aged ≥65 years, and by all mechanisms.

CONCLUSIONS

Comprehensive suicide prevention strategies tailored to rural communities may mitigate the rural-urban disparity in morbidity from suicidal behavior.

Skala Suizidales Erleben und Verhalten (SSEV)

Zusammenfassung. Suizidales Erleben und Verhalten ist in klinischen Kontexten sehr verbreitet. Während international diverse Messinstrumente zur Erfassung von Suizidalität entwickelt und validiert wurden, gibt es nur wenige deutsche Messinstrumente. In der vorliegenden Studie wurde die neu entwickelte Skala Suizidales Erleben und Verhalten (SSEV) in fünf Stichproben mit insgesamt N = 1 099 Proband_innen im Hinblick auf ihre psychometrischen Eigenschaften untersucht. Die faktorenanalytische Untersuchung (explorative und konfirmatorische Faktorenanalyse) ergab eine eindimensionale Struktur des Fragebogens. Die interne Konsistenz der SSEV ist hoch und es zeigten sich erwartungsgemäß positive Zusammenhänge zu diversen Maßen aktueller Theoriemodelle suizidalen Erlebens und Verhaltens, sowie zu Depressivität, Angst und Stress. Weitere Analysen zeigten erwartungskonform negative Zusammenhänge mit sozialer Unterstützung und positiver mentaler Gesundheit. Insgesamt verweisen die Ergebnisse darauf, dass es sich beim SSEV um ein reliables und valides Instrument zur Erfassung von akutem suizidalem Erleben und Verhalten handelt, welches in der Forschung und der klinischen Praxis angewendet werden kann.

Assessment of Suicidal Intent in Self-directed Violence and Subsequent Care Received Among Military Veterans: A National Study of Gender Differences

BACKGROUND

The Veterans Health Administration's system for documenting self-directed violence (SDV) requires that clinicians make a determination of the suicidal intent of the behavior (ie, "undetermined" intent vs. "suicide attempt") which contributes to the enhanced care offered. Past studies suggest clinicians' judgment of suicide risk is impacted by patient demographics regardless of clinical presentation. As women are less likely to die by suicide than men, women's SDV may be taken less seriously; they may be more likely to have their SDV classified as "undetermined" than men, which may impact the care received.

OBJECTIVES

This study examines whether women veterans' SDV is disproportionately classified as "undetermined" suicidal intent versus "suicide attempt" as compared with men veterans, and how one's classification and gender modifies the care received.

RESEARCH DESIGN

This was an observational, retrospective study of data from Veterans Health Administration administrative databases. We included all veterans with documented nonfatal "undetermined" SDV events and "suicide attempts" between 2013 and 2018 (N=55,878). Objectives were evaluated using mixed-effects logistic regression models.

RESULTS

Women veterans were disproportionately more likely than men veterans to have SDV classified as "undetermined" (odds ratio=1.17; 95% confidence interval, 1.08-1.27). Veterans who received an "undetermined" classification were significantly less likely to receive enhanced care. However, this relationship was not moderated by gender.

CONCLUSIONS

Gender may impact clinicians' determinations of intent of SDV, but more research is needed on the extent of classification biases and to understand causes. Further, classification of intent is critical, as there is a strong relationship between classification and enhanced care.

[Development of an Online Intervention for Adolescents and Young Adults Engaging in Nonsuicidal Self-injury]

Development of an Online Intervention for Adolescents and Young Adults Engaging in Nonsuicidal Self-injury Nonsuicidal self-injury (NSSI) is a prevalent phenomenon in adolescence. Despite the existence of effective psychotherapeutic interventions, the majority of affected adolescents and young adults do not receive any treatment. Structural (e. g., no specific interventions, limited resources, limited accessibility) as well as individual factors (e. g., low help-seeking behavior) impede access to adequate clinical care for adolescent NSSI. Online interventions offer the possibility to provide specific interventions independent of one's location or local healthcare structures. Because of its high confidentiality and accessibility, the Internet also reaches adolescents with low help-seeking behavior. There is already evidence for online interventions concerning different mental health issues, like depression and anxiety. However, regarding NSSI, there are no effective, online interventions. Thus, we developed an online intervention based on an already evaluated short term program specific for adolescents and young adults with NSSI within the German STAR consortium (STAR: Self-Injury - Treatment, Assessment, Recovery). Within a randomised controlled trial, the intervention will be evaluated regarding its efficacy.

An Investigation Into the Factor Structure of the Attitudes to Suicide Prevention Scale

Aim: The aim of this study was to investigate the factor structure of the Attitudes to Suicide Prevention Scale (ASPS). Method: The ASPS was distributed to all staff in a UK National Health Service Trust (N = 957). We conducted an exploratory factor analysis followed by a confirmatory factor analysis by splitting the data 60/40 into training and testing subsets. A multiple regression analysis was carried out to investigate whether the overall scale score varied as a function of professional role, age, and gender and whether respondents had completed suicide prevention training or not. Results: Two items displaying poor item-scale correlation were excluded from the factor analysis and a further item was excluded as it was based on different anchor points. For the remaining 11 items, no adequate factor structure emerged. The scale total demonstrated statistically significant differences in attitudes between staff groups (defined by attendance at suicide awareness or prevention training, by gender, and by level of patient contact), but not between groups defined by age range. Generally, however, there were positive attitudes across all Trust staff. Limitations: This study had a low response rate (24%) and was cross-sectional which limits the conclusions that could be drawn. Furthermore, other areas such as convergent validity and test-retest reliability were not examined. Conclusion: Our findings found no satisfactory factor structure for the ASPS. Further scale development would be beneficial.

Pathways linking clinician demographics to mental health diagnostic accuracy: An international perspective

OBJECTIVE

This study examined the impact of clinicians' demographics and response time on diagnostic accuracy.

METHOD

We conducted mediation analyses on data from a WHO field study of the ICD-11 that required clinicians (N = 1,822, 44.3% female, 44.92 years old) to diagnose two case vignettes.

RESULTS

Contradictory to decision-making theories, clinicians with more years of experience and slower response times had higher rates of diagnostic accuracy. In comparison to North American clinicians, clinicians in Asia who responded faster had lower accuracy rates, and clinicians in South America who responded slower had higher accuracy rates. Medical professionals with quicker response times had lower accuracy rates compared with psychologists and other clinical professionals.

CONCLUSION

Findings indicate that clinicians should consider how their clinical setting, level of experience, and response time influence the diagnostic process. Future research on diagnostic accuracy should consider additional mediating factors, such as cultural differences in response time.

Suicidal ideation in patients with coronary heart disease and hypertension: Baseline results from the DEPSCREEN-INFO clinical trial

BACKGROUND

A high proportion of cardiac patients suffers from depression, which is an antecedent for suicidal ideation. This study identifies clinical vulnerabilities for suicidal ideation in cardiac patients.

METHODS

The primary outcome of the study was severity of suicidal ideation as measured with the Patient Health Questionnaire (PHQ-9) item No. 9. Covariates were demographics, cardiac characteristics (i.e., Canadian Cardiovascular Society angina rating of chest pain and New York Heart Association rating of shortness of breath), depression (PHQ-8,i.e., PHQ-9 minus item No. 9), anxiety (Generalized Anxiety Disorder-7, GAD-7), somatic symptoms (PHQ-15), illness perception (Brief-Illness Perception Questionnaire), and health-related quality of life (EuroQol-5D, EQ 5D).

RESULTS

Data from 1,976 patients were analysed. At least 14% (95% CI [12%, 16%]) of patients indicated suicidal ideations within the last 2 weeks. Bivariate analyses yielded associations between suicidal ideation and higher levels of depression severity, anxiety severity, somatic symptom burden, chest pain, shortness of breath, negative illness perceptions, reduced health-related quality of life, and a higher probability of living alone (all p < 0.001). A multivariable ordinal regression revealed depression severity and anxiety severity to show the highest associations with suicidal ideation (OR_PHQ-8  = 1.22, p < 0.001; OR_GAD-7  = 1.09, p < 0.001). Having a defibrillator implant was associated with a lower probability of suicidal ideation (OR = 0.27, p = 0.017).

CONCLUSIONS

This study identified several clinical vulnerabilities of suicidal ideation. The results stress the importance of screening for suicidal ideation in clinical practice.

Strukturierte klinische Interviews zur Erfassung psychischer Störungen über die Lebensspanne

Zusammenfassung. Psychische Störungen können über die ganze Lebensspanne auftreten. Strukturierte klinische Interviews sind zentrale Hilfsmittel für ihre rasche, zuverlässige und umfassende Diagnostik. Im deutschsprachigen Raum stehen mit den Verfahren der DIPS-Familie Interviews zur Diagnostik psychischer Störungen über die gesamte Lebensspanne zur Verfügung, die seit den 90er Jahren regelmäßig aktualisiert wurden. Ihre Reliabilität, Validität und Akzeptanz wurde wiederholt in großen Stichproben aus ambulanten, stationären und Forschungssettings überprüft. Die Einführung des DSM-5 erforderte eine umfassende Überarbeitung der DIPS-Interviews, deren wesentliche Merkmale dargestellt werden. Um die breitere Verwendung von strukturierten klinischen Interviews zu fördern, werden die Verfahren der DIPS-Familie neu als „Open Access-Dokumente“ zur Verfügung gestellt. Abschließend werden weitere Entwicklungen zu Training, Dissemination und Computerisierung im Ausblick angesprochen.

Information order effects in clinical psychological diagnoses

Despite the wide application and long history of diagnostic systems, several sources of diagnostic errors remain in the criterion-based diagnosing of mental disorders. The aim of this study was to investigate whether the presentational order of diagnosis-relevant information and pretreatment reports predict diagnostic errors. One hundred twenty psychotherapists participated in the present online study. The study employed a 2 (symptom presentation: core symptoms at vignette's beginning vs. core symptoms at the end of the case vignette) × 2 (pretreatment report: receiving a pretreatment report with an incongruent diagnosis to the case vignette vs. receiving no pretreatment report) between-subjects experimental design, with random assignment. Participants were asked to make diagnoses after reading three case vignettes describing patients with different disorder constellations. Additionally, participants rated their confidence in the diagnoses and their estimation of the severity of each diagnosed condition. Results indicated that order of symptom descriptions predicted the correctness of diagnostic decisions, with a recency effect causing more fully correct diagnostic decisions in cases where diagnostic information was presented last. Receiving incongruent pretreatment reports was predictive for diagnostic errors. In conclusion, the results of this study indicate that diagnoses of mental disorders can depend on the way symptoms are presented or reported.

KEY PRACTITIONER MESSAGE

Therapists' diagnostic decisions are not influenced by pretreatment reports. Diagnostic decisions are affected by information order effects. Diagnostic accuracy of psychotherapists is debatable. High rate of misdiagnoses in case vignette with comorbid disorders.

Psychopathological Differences Between Suicide Ideators and Suicide Attempters in Patients with Mental Disorders

BACKGROUND

Although suicide is one of the leading causes of death worldwide, there is a need for studies to identify variables that can differentiate patients with suicide ideation at risk of transitioning to an attempt.

METHOD

In this study, we assessed suicide ideation and attempts, non-suicidal self-injury (NSSI), hopelessness, borderline symptoms and meaning in life in a sample of 348 patients with different diagnoses of mental disorders. We divided the sample into four subgroups: patients without suicide ideation or suicide attempts; patients with current suicide ideation; patients with lifetime suicide attempts and patients with a suicide attempt in the previous year.

RESULTS

The group with suicide attempts in the previous year showed higher levels of hopelessness, borderline symptoms and NSSI, and lower levels of meaning in life than the other groups.

LIMITATIONS

Groups were composed of unequal numbers of patients, and in some of them, the sample size was small. The sample was composed mainly of women with eating disorders. The study design was retrospective, and so the results must be considered in terms of correlates.

CONCLUSIONS

Our results suggest that hopelessness, borderline symptoms-including NSSI-and meaning in life play a key role in suicide attempts. Thus, psychotherapeutic interventions should focus on managing NSSI, searching for meaning and managing emptiness, loss of control and feelings such as self-contempt in patients with suicide ideation. Copyright © 2016 John Wiley & Sons, Ltd.

KEY PRACTITIONER MESSAGE

Recent suicide attempters show higher levels of hopelessness, borderline symptoms and NSSI than lifetime attempters and suicide ideators. Clinicians should focus attention on assessing hopelessness, borderline symptoms and NSSI in those with suicide ideation. Lower levels of meaning in life are related to recent suicide attempts. Levels of hopelessness differentiate between recent and lifetime suicide attempters.

An Investigation of Diagnostic Accuracy and Confidence Associated with Diagnostic Checklists as Well as Gender Biases in Relation to Mental Disorders

This study examines the utility of checklists in attaining more accurate diagnoses in the context of diagnostic decision-making for mental disorders. The study also aimed to replicate results from a meta-analysis indicating that there is no association between patients’ gender and misdiagnoses. To this end, 475 psychotherapists were asked to judge three case vignettes describing patients with Major Depressive Disorder (MDD), Generalized Anxiety Disorder, and Borderline Personality Disorder. Therapists were randomly assigned to experimental conditions in a 2 (diagnostic method: with using diagnostic checklists vs. without using diagnostic checklists) × 2 (gender: male vs. female case vignettes) between-subjects design. Multinomial logistic and linear regression analyses were used to examine the association between the usage of diagnostic checklists as well as patients’ gender and diagnostic decisions. The results showed that when checklists were used, fewer incorrect co-morbid diagnoses were made, but clinicians were less likely to diagnose MDD even when the criteria were met. Additionally, checklists improved therapists’ confidence with diagnostic decisions, but were not associated with estimations of patients’ characteristics. As expected, there were no significant associations between gender and diagnostic decisions.