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Ferzan Ergün F, Kazan Kızılkurt Ö, Yazıcı M, Güleç H. Validity, Reliability, and Factor Structure of the Suicide Crisis Scale in Turkish. ALPHA PSYCHIATRY 2024; 25:502-512. [PMID: 39360296 PMCID: PMC11443287 DOI: 10.5152/alphapsychiatry.2024.241564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 05/27/2024] [Indexed: 10/04/2024]
Abstract
Objective In our study, we aimed to adapt the Suicide Crisis Inventory (SCI), which can be used specifically to assess the acute phase of suicide, to the Turkish population by examining its Turkish validity and reliability in a non-clinical sample. Methods In this cross-sectional study, a total of 300 university students aged 18-24 years were evaluated online using the Socio-demographic and Clinical Data Form, the SCI, and the Suicide Behavior Questionnaire (SBQ). Criterion validity, discriminative validity, and factor analyses (exploratory and confirmatory) were conducted for the validity of the SCI, and internal consistency and item-total correlations were examined for reliability analyses. Additionally, a linear regression model was constructed to assess the predictive validity of the SCI. The predictive validity of past SCI scores was evaluated using a simple regression model. Results When the linear regression model was tested with SCI scores as the independent variable and SBQ scores as the dependent variable [F(1-298) = 203.625; P = .000], it was found that the independent variable explained 41% of the variance in the dependent variable (r = 0.637; r 2 = 0.406). SCI scores significantly predicted SBQ scores (t = 14.270; B = 0.047; Bsth = 0.003; β = 0.647; P = .000). In the validity analysis, the items removed from the scale could be evaluated for the total score, as they did not belong to any factor as originally specified. When items were removed, the total item reliability was Cronbach's alpha = 0.981. Conclusion We believe that the SCI will be a useful tool in assessing short-term suicide risk in a Turkish sample and in conducting scientific research. The SCI was found to be sufficient for use in a Turkish sample for the evaluation of short-term suicide risk, considering some limitations.
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Affiliation(s)
- Fikret Ferzan Ergün
- Department of Psychiatry, University of Health Sciences Erenköy Training and Research Hospital for Psychiatric and Neurological Diseases, Istanbul, Türkiye
| | | | - Medine Yazıcı
- Department of Psychiatry, University of Health Sciences Erenköy Training and Research Hospital for Psychiatric and Neurological Diseases, Istanbul, Türkiye
| | - Hüseyin Güleç
- Department of Psychiatry, University of Health Sciences Erenköy Training and Research Hospital for Psychiatric and Neurological Diseases, Istanbul, Türkiye
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De Luca GP, Parghi N, El Hayek R, Bloch-Elkouby S, Peterkin D, Wolfe A, Rogers ML, Galynker I. Machine learning approach for the development of a crucial tool in suicide prevention: The Suicide Crisis Inventory-2 (SCI-2) Short Form. PLoS One 2024; 19:e0299048. [PMID: 38728274 PMCID: PMC11086905 DOI: 10.1371/journal.pone.0299048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 02/04/2024] [Indexed: 05/12/2024] Open
Abstract
The Suicide Crisis Syndrome (SCS) describes a suicidal mental state marked by entrapment, affective disturbance, loss of cognitive control, hyperarousal, and social withdrawal that has predictive capacity for near-term suicidal behavior. The Suicide Crisis Inventory-2 (SCI-2), a reliable clinical tool that assesses SCS, lacks a short form for use in clinical settings which we sought to address with statistical analysis. To address this need, a community sample of 10,357 participants responded to an anonymous survey after which predictive performance for suicidal ideation (SI) and SI with preparatory behavior (SI-P) was measured using logistic regression, random forest, and gradient boosting algorithms. Four-fold cross-validation was used to split the dataset in 1,000 iterations. We compared rankings to the SCI-Short Form to inform the short form of the SCI-2. Logistic regression performed best in every analysis. The SI results were used to build the SCI-2-Short Form (SCI-2-SF) utilizing the two top ranking items from each SCS criterion. SHAP analysis of the SCI-2 resulted in meaningful rankings of its items. The SCI-2-SF, derived from these rankings, will be tested for predictive validity and utility in future studies.
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Affiliation(s)
- Gabriele P. De Luca
- Department of Psychiatry, Faculty of Medicine and Psychology, University of Rome Sapienza, Rome, Italy
| | - Neelang Parghi
- Department of Biology, New York University, New York City, New York, United States of America
| | - Rawad El Hayek
- Department of Psychiatry, Mount Sinai Beth Israel, New York City, New York, United States of America
- Icahn School of Medicine at Mount Sinai, New York City, New York, United States of America
| | - Sarah Bloch-Elkouby
- Department of Psychiatry, Mount Sinai Beth Israel, New York City, New York, United States of America
- Icahn School of Medicine at Mount Sinai, New York City, New York, United States of America
| | - Devon Peterkin
- Department of Psychiatry, Mount Sinai Beth Israel, New York City, New York, United States of America
- Icahn School of Medicine at Mount Sinai, New York City, New York, United States of America
| | - Amber Wolfe
- Department of Psychiatry, Mount Sinai Beth Israel, New York City, New York, United States of America
- Icahn School of Medicine at Mount Sinai, New York City, New York, United States of America
| | - Megan L. Rogers
- Department of Psychology, Texas State University, San Marcos, Texas, United States of America
| | - Igor Galynker
- Department of Psychiatry, Mount Sinai Beth Israel, New York City, New York, United States of America
- Icahn School of Medicine at Mount Sinai, New York City, New York, United States of America
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Peper-Nascimento J, Rogers ML, Richards JA, Diaz AP, Ceretta LB, Keller GS, Quevedo J, Galynker I, Valvassori SS. Suicide Crisis Inventory-2: factor structure, internal consistency, and validity in a Brazilian sample. REVISTA BRASILEIRA DE PSIQUIATRIA (SAO PAULO, BRAZIL : 1999) 2024; 46:e20233366. [PMID: 38377007 PMCID: PMC11427985 DOI: 10.47626/1516-4446-2023-3366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 01/27/2024] [Indexed: 02/22/2024]
Abstract
OBJECTIVE To evaluate the factor structure, reliability, and validity of the Brazilian version of the Suicide Crisis Inventory-2 (SCI-2) among Brazilian adults. METHODS The SCI-2 was cross-culturally adapted into Portuguese and administered to 2,265 Brazilian participants. Confirmatory factor analysis (CFA) was used to assess factor structure, internal consistency, convergent validity, and criterion validity by using measures such as suicidal narratives, stressful life events, suicidal ideation, and suicide attempts. RESULTS The revised one-factor model of the SCI-2 demonstrated an adequate, although not optimal, model fit (?2[1539] = 31,442.79, p < 0.001, comparative fit index [CFI] = 0.99, Tucker-Lewis index [TLI] = 0.99, root mean square error of approximation [RMSEA] = 0.09, standardized root mean residual [SRMR] = 0.05). The revised five-factor model, on the other hand, demonstrated good fit (?2[1529] = 14,174.86, p < 0.001, CFI = 1.00, TLI = 1.00, RMSEA = 0.06, SRMR = 0.04). Comparison of these two models indicated that the five-factor model had a better fit than the one-factor model. Both the total and subscale scores of the SCI-2 showed strong internal consistency and good convergent and criterion validity in relation to stressful life events, suicidal narratives (excluding the goal disengagement subscale), suicidal ideation, and suicide attempts. CONCLUSION Our findings suggest that the Brazilian version of the SCI-2 is a valid tool for assessing symptoms of suicidal crisis syndrome.
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Affiliation(s)
- Jefté Peper-Nascimento
- Programa de Pós-Graduação em Ciências da Saúde, Laboratório de Psiquiatria Translacional, Universidade do Extremo Sul Catarinense, Criciúma, SC, Brazil
| | - Megan L. Rogers
- Department of Psychology, Texas State University, San Marcos, TX, USA
| | - Jenelle A. Richards
- Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel Hospital, New York, NY, USA
| | - Alexandre Paim Diaz
- Center for the Study and Prevention of Suicide, Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
| | - Luciane B. Ceretta
- Programa de Pós-Graduação em Ciências da Saúde, Laboratório de Psiquiatria Translacional, Universidade do Extremo Sul Catarinense, Criciúma, SC, Brazil
| | - Gabriela S. Keller
- Programa de Pós-Graduação em Ciências da Saúde, Laboratório de Psiquiatria Translacional, Universidade do Extremo Sul Catarinense, Criciúma, SC, Brazil
| | - João Quevedo
- Programa de Pós-Graduação em Ciências da Saúde, Laboratório de Psiquiatria Translacional, Universidade do Extremo Sul Catarinense, Criciúma, SC, Brazil
- Center for Interventional Psychiatry, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth Houston), Houston, TX, USA
| | - Igor Galynker
- Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel Hospital, New York, NY, USA
| | - Samira S. Valvassori
- Programa de Pós-Graduação em Ciências da Saúde, Laboratório de Psiquiatria Translacional, Universidade do Extremo Sul Catarinense, Criciúma, SC, Brazil
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Park JY, Rogers ML, Bloch-Elkouby S, Richards JA, Lee S, Galynker I, You S. Factor Structure and Validation of the Revised Suicide Crisis Inventory in a Korean Population. Psychiatry Investig 2023; 20:162-173. [PMID: 36891601 PMCID: PMC9996151 DOI: 10.30773/pi.2022.0208] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 12/07/2022] [Indexed: 02/25/2023] Open
Abstract
OBJECTIVE Because of the exceptionally high suicide rates in South Korea, new assessment methods are needed to improve suicide prevention. The current study aims to validate the revised Suicide Crisis Inventory-2 (SCI-2), a self-report measure that assesses a cognitiveaffective pre-suicidal state in a Korean sample. METHODS With data from 1,061 community adults in South Korea, confirmatory factor analyses were first conducted to test the proposed one-factor and five-factor structures of the SCI-2. Also, an exploratory factor analysis (EFA) was performed to examine possible alternative factor structure of the inventory. RESULTS The one-factor model of the SCI-2 resulted in good model fit and similarly, the five-factor model also exhibited strong fit. Comparing the two models, the five-factor was evaluated as the superior model fit. An alternative 4-factor model derived from EFA exhibited a comparable model fit. The Korean version of the SCI-2 had high internal consistency and strong concurrent validity in relation to symptoms of suicidal ideation, depression, and anxiety. CONCLUSION The SCI-2 is an appropriate and a valid tool for measuring one's proximity to imminent suicide risk. However, the exact factor structure of the SCI-2 may be culture-sensitive and warrants further study.
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Affiliation(s)
- Ji Yoon Park
- Icahn School of Medicine, Mount Sinai Beth Israel, New York, NY, USA.,Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, NY, USA
| | - Megan L Rogers
- Department of Psychology, Texas State University, San Marcos, TX, USA
| | | | | | - Sungwoo Lee
- Department of Psychology, Chungbuk National University, Cheongju, Republic of Korea
| | - Igor Galynker
- Icahn School of Medicine, Mount Sinai Beth Israel, New York, NY, USA
| | - Sungeun You
- Department of Psychology, Chungbuk National University, Cheongju, Republic of Korea
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Menon V, Bafna AR, Rogers ML, Richards J, Galynker I. Factor structure and validity of the Revised Suicide Crisis Inventory (SCI-2) among Indian adults. Asian J Psychiatr 2022; 73:103119. [PMID: 35447538 DOI: 10.1016/j.ajp.2022.103119] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 04/07/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND There is a dearth of cross-cultural data on the psychometric properties of the revised Suicide Crisis Inventory (SCI)- 2. Our objective was to examine the factor structure, reliability, and validity of the SCI-2 among Indian adults. METHODS Using an online survey method, between August 20, 2020 and January 31, 2021, an anonymous questionnaire containing general sociodemographic information and self-report measures was circulated over email and social media. Confirmatory factor analyses (CFA) of the SCI-2 was carried out. We also examined the internal consistency of the SCI-2 and tested its convergent validity against the Suicide Narrative Inventory (SNI) and the Perceived Stress Scale (PSS-10). RESULTS A total of 302 participants (Mean age = 43.5 ± 17.9 years, 53.6% female) were obtained. Results of the one-factor CFA indicated good model fit (χ2[1769] = 5368.75, p < 0.001, Comparative Fit Index [CFI] =0.99, Root mean square error of approximation [RMSEA] =0.08). Similarly, the five-factor CFA also exhibited strong model fit (χ2[1759] = 4215.54, p < 0.001, CFI = 1.00, RMSEA =0.07). Comparison of these models indicated that the five-factor model demonstrated superior model fit (Δχ2[10] = 278.88, p < 0.001). The SCI-2 total and subscale scores showed excellent internal consistency and good convergent validity against most domains of the SNI and PSS-10. CONCLUSION Among Indian adults, the SCI-2 demonstrated good psychometric properties with the proposed five-factor solution providing the best fit. These findings provide support for the SCI construct and its assessment with the SCI-2 in an Asian setting.
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Affiliation(s)
- Vikas Menon
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry 605006, India.
| | - Anokhi Rajiv Bafna
- Icahn School of Medicine, Mount Sinai Beth Israel Hospital, New York, NY 10003, USA
| | - Megan L Rogers
- Icahn School of Medicine, Mount Sinai Beth Israel Hospital, New York, NY 10003, USA
| | - Jenelle Richards
- Icahn School of Medicine, Mount Sinai Beth Israel Hospital, New York, NY 10003, USA
| | - Igor Galynker
- Icahn School of Medicine, Mount Sinai Beth Israel Hospital, New York, NY 10003, USA
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Cohen LJ, Mokhtar R, Richards J, Hernandez M, Bloch-Elkouby S, Galynker I. The Narrative-Crisis Model of suicide and its prediction of near-term suicide risk. Suicide Life Threat Behav 2022; 52:231-243. [PMID: 34766360 DOI: 10.1111/sltb.12816] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 08/19/2021] [Accepted: 09/07/2021] [Indexed: 12/15/2022]
Abstract
Despite decades of research, much remains unknown about the transition from chronic to imminent suicidal risk. In the context of COVID-19, this question is even more urgent. The present study tests a novel, stepwise model of this transition, termed the Narrative-Crisis Model. This model proposes that, in people with chronic risk factors, stressful life events can trigger a specific progression of cognitive-affective responses (the suicidal narrative and the suicide crisis syndrome), resulting in increased near-term risk of suicidal thoughts and behavior (STB). Identification of each step in this progression provides opportunities for more precise interventions. Concurrent validity was tested with 732 psychiatric patients and predictive validity with 524 participants, assessed one to two months later. Chronic risk factors were measured with the Childhood Trauma Questionnaire, Relationship Styles Questionnaire, and UPPS-P Impulsive Behavior Scale; acute risk factors with the Stressful Life Events Questionnaire, Suicide Narrative Inventory, and Suicide Crisis Inventory. The Columbia Suicide Severity Rating Scale was administered at the initial research assessment and follow-up. Indirect effects were significant for the full model and most pathways, in both concurrent and prospective analyses. In sum, this study provides empirical support for a novel, stepwise model of the progression from chronic to near-term suicidal risk.
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Affiliation(s)
- Lisa Janet Cohen
- Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Psychiatry, Mount Sinai Beth Israel, New York, New York, USA
| | - Radwa Mokhtar
- Graduate School of Applied and Professional Psychology, Rutgers University, Piscataway, New Jersey, USA
| | - Jenelle Richards
- Department of Psychiatry, Mount Sinai Beth Israel, New York, New York, USA
| | - Michelle Hernandez
- Department of Psychology, The City College of New York, New York, New York, USA
| | | | - Igor Galynker
- Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Psychiatry, Mount Sinai Beth Israel, New York, New York, USA
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Bloch-Elkouby S, Barzilay S, Gorman BS, Lawrence OC, Rogers ML, Richards J, Cohen LJ, Johnson BN, Galynker I. The revised suicide crisis inventory (SCI-2): Validation and assessment of prospective suicidal outcomes at one month follow-up. J Affect Disord 2021; 295:1280-1291. [PMID: 34706442 DOI: 10.1016/j.jad.2021.08.048] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 08/10/2021] [Accepted: 08/21/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND AIM The Suicide Crisis Syndrome (SCS) is an evidence-based pre-suicidal cognitive and affective state predictive of short-term suicide risk. The most recent SCS formulation, proposed as a suicide-specific DSM diagnosis, features a feeling of Entrapment accompanied by four additional symptom clusters: Affective Disturbance; Loss of Cognitive Control; Hyperarousal; and Social Withdrawal. The aim of the present study was to revise the Suicide Crisis Inventory (SCI; Barzilay et al., 2020), a self-report measure assessing the presence of the SCS,in accordance with the current SCS formulation, as well as to assess the psychometric properties and clinical utility of its revised version, the Suicide Crisis Inventory-2 (SCI-2). METHODS The SCI-2, a 61-item self-report questionnaire, was administered to 421 psychiatric inpatients and outpatients at baseline. Prospective suicidal outcomes including suicidal ideation, preparatory acts, and suicidal attempts were assessed after one month. Internal structure and consistency were assessed with confirmatory factor analysis, convergent, discriminant, and current criterion validity. Receiver-operating characteristic (ROC) curves with Area under the Curve (AUC) were used to examine the predictive validity of the SCI-2 to prospective outcomes. Exploratory analyses assessed the predictive validity of the five SCI-2 dimensions. RESULTS The SCI-2 demonstrated excellent internal consistency (Cronbach's α = 0.971), good convergent, discriminant, and current criterion validity. The SCI-2 significantly predicted all three outcomes, and was the only significant predictor of suicidal attempts with AUC = 0.883. DISCUSSION The results of this study indicate that the SCI-2 is a valid and reliable tool to assess the presence and intensity of the Suicide Crisis Syndrome and to predict short-term prospective suicidal behaviors and attempts among psychiatric outpatients and inpatients regardless of patients' readiness to disclose suicidal ideation.
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Affiliation(s)
- Sarah Bloch-Elkouby
- Icahn School of Medicine at Mount Sinai 1 Gustave L. Levy Pl, New York, NY 10029, United States.
| | - Shira Barzilay
- Icahn School of Medicine at Mount Sinai 1 Gustave L. Levy Pl, New York, NY 10029, United States
| | - Bernard S Gorman
- Icahn School of Medicine at Mount Sinai 1 Gustave L. Levy Pl, New York, NY 10029, United States
| | - Olivia C Lawrence
- Icahn School of Medicine at Mount Sinai 1 Gustave L. Levy Pl, New York, NY 10029, United States
| | - Megan L Rogers
- Icahn School of Medicine at Mount Sinai 1 Gustave L. Levy Pl, New York, NY 10029, United States
| | - Jenelle Richards
- Icahn School of Medicine at Mount Sinai 1 Gustave L. Levy Pl, New York, NY 10029, United States
| | - Lisa J Cohen
- Icahn School of Medicine at Mount Sinai 1 Gustave L. Levy Pl, New York, NY 10029, United States
| | - Benjamin N Johnson
- Icahn School of Medicine at Mount Sinai 1 Gustave L. Levy Pl, New York, NY 10029, United States
| | - Igor Galynker
- Icahn School of Medicine at Mount Sinai 1 Gustave L. Levy Pl, New York, NY 10029, United States
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McMullen L, Parghi N, Rogers ML, Yao H, Bloch-Elkouby S, Galynker I. The role of suicide ideation in assessing near-term suicide risk: A machine learning approach. Psychiatry Res 2021; 304:114118. [PMID: 34403873 DOI: 10.1016/j.psychres.2021.114118] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 07/09/2021] [Accepted: 07/13/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND The majority of suicide attempters do not disclose suicide ideation (SI) prior to making an attempt. When reported, SI is nevertheless associated with increased risk of suicide. This paper implemented machine learning (ML) approaches to assess the degree to which current and lifetime SI affect the predictive validity of the Suicide Crisis Syndrome (SCS), an acute condition indicative of imminent risk, for near-term suicidal behaviors (SB ). METHODS In a sample of 591 high-risk inpatient participants, SCS and SI were respectively assessed using the Suicide Crisis Inventory (SCI) and the Columbia Suicide Severity Rating Scale (C-SSRS). Two ML predictive algorithms, Random Forest and XGBoost, were implemented and framed using optimism adjusted bootstrapping. Metrics collected included AUPRC, AUROC, classification accuracy, balanced accuracy, precision, recall, and brier score. AUROC metrics were compared by computing a z-score. RESULTS The combination of current SI and SCI showed slightly higher predictive validity for near-term SB as evidenced by AUROC metrics than the SCI alone, but the difference was not significant (p<0.05). Current SI scored the highest amongst a chi square distribution in regards to predictors of near-term SB. CONCLUSION The addition of SI to the SCS does not materially improve the model's predictive validity for near-term SB, suggesting that patient self-reported SI should not be a requirement for the diagnosis of SCS.
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Affiliation(s)
- Lauren McMullen
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City, NY U.S.A.
| | - Neelang Parghi
- Courant Institute of Mathematical Sciences, New York University, New York City, NY U.S.A
| | - Megan L Rogers
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City, NY U.S.A
| | - Heng Yao
- College of Engineering, University of Florida, Gainesville, FL, U.S.A
| | - Sarah Bloch-Elkouby
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City, NY U.S.A
| | - Igor Galynker
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City, NY U.S.A
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Rogers ML, Cao E, Sinclair C, Galynker I. Associations between goal orientation and suicidal thoughts and behaviors at one-month follow-up: Indirect effects through ruminative flooding. Behav Res Ther 2021; 145:103945. [PMID: 34399271 DOI: 10.1016/j.brat.2021.103945] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 07/24/2021] [Accepted: 08/10/2021] [Indexed: 12/29/2022]
Abstract
Previous research has identified both goal orientation and ruminative flooding as potential risk factors for suicidal thoughts and behaviors, as well as positive associations between goal orientation and rumination. The present study examined whether the association between goal orientation and suicidal thoughts and behaviors, assessed one month later, was accounted for by ruminative flooding. A sample of 924 psychiatric outpatients (Mage = 39.09 years, SD = 14.82, range = 18 to 84; 61.7% female; 37.0% White) completed self-report and interview measures at baseline and provided information about suicide-related outcomes at one-month follow-up. Goal orientation was positively associated with ruminative flooding, and both goal orientation and ruminative flooding were associated with suicidal thoughts and behaviors at one-month follow-up. Controlling for lifetime suicidal thoughts and behaviors, as well as patient age and sexual orientation, ruminative flooding accounted for the relationship between goal orientation and suicidal thoughts and behaviors at one-month follow-up. These findings were especially relevant for individuals with a history of multiple suicide attempts. Overall, this study provided evidence that difficulties with goal orientation may relate to suicidal thoughts and behaviors through intense ruminations perceived as a loss of cognitive control. Interventions that address ruminative thinking and cognitive flexibility may, in turn, assist in reducing emotion dysregulation and managing suicidality among those who struggle with goal orientation.
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Affiliation(s)
| | - Erjia Cao
- Icahn School of Medicine, Mount Sinai Beth Israel, USA; Department of Counseling and Clinical Psychology, Teachers College, Columbia University, USA
| | - Courtney Sinclair
- Department of Counseling and Clinical Psychology, Teachers College, Columbia University, USA
| | - Igor Galynker
- Icahn School of Medicine, Mount Sinai Beth Israel, USA
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Ying G, Chennapragada L, Musser ED, Galynker I. Behind therapists' emotional responses to suicidal patients: A study of the narrative crisis model of suicide and clinicians' emotions. Suicide Life Threat Behav 2021; 51:684-695. [PMID: 33486794 PMCID: PMC8693386 DOI: 10.1111/sltb.12730] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 09/01/2020] [Accepted: 11/20/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Clinicians' negative emotional responses to suicidal patients are predictive of near-term suicidality. This study aimed to explore the underlying pathway of this association by investigating the potential relationship between clinicians' emotional responses and the Narrative Crisis Model of suicide, which comprises long-term risk factors (LTRF) of suicidal thoughts and behaviors, Suicidal Narrative, and the Suicide Crisis Syndrome (SCS), a presuicidal affective state. METHOD One thousand and One patient participants and 169 clinician participants were recruited. Patients' Suicidal Narrative, SCS, and LTRF were assessed at intake using the Suicidal Narrative Inventory (SNI), the Suicide Crisis Inventory, and a composite score of three separate scales, respectively. Clinicians' emotional responses were measured immediately after patient intake using the Therapist Response Questionnaire-Suicide Form (TRQ-SF). RESULTS Multilevel regression analyses, which controlled for clinician differences, found that only patients' SNI total score and perceived burdensomeness subscale score were significantly associated with clinicians' TRQ-SF total score. Furthermore, a higher SNI total score was significantly related to higher distress and lower affiliation scores among clinicians. CONCLUSIONS Clinicians appear to respond emotionally to patients' Suicidal Narrative, and thus, future investigation of Suicidal Narrative and its potential to improve imminent suicide risk assessment is warranted.
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Affiliation(s)
- Gelan Ying
- Department of Psychiatry and Behavioral Health, Mount Sinai Beth Israel Medical Center, New York City, NY, USA
| | - Lakshmi Chennapragada
- Department of Psychiatry and Behavioral Health, Mount Sinai Beth Israel Medical Center, New York City, NY, USA
| | - Erica D. Musser
- Division of Clinical Science, Department of Psychology, Florida International University, Miami, FL, USA
| | - Igor Galynker
- Department of Psychiatry and Behavioral Health, Mount Sinai Beth Israel Medical Center, New York City, NY, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
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11
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Bloch-Elkouby S, Gorman B, Lloveras L, Wilkerson T, Schuck A, Barzilay S, Calati R, Schnur D, Galynker I. How do distal and proximal risk factors combine to predict suicidal ideation and behaviors? A prospective study of the narrative crisis model of suicide. J Affect Disord 2020; 277:914-926. [PMID: 33065834 DOI: 10.1016/j.jad.2020.08.088] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 07/17/2020] [Accepted: 08/25/2020] [Indexed: 12/25/2022]
Abstract
AIM The Narrative Crisis Model of suicide posits that when individuals with trait vulnerabilities for suicide face stressful life events, they may develop distorted perceptions of themselves and society that culminate in a sense of no future. Referred to as the suicide narrative, these perceptions makes them more likely to experience the Suicidal Crisis Syndrome, an acute affective condition that increases the risk of engaging in suicidal ideation behaviors. The goal of this study was to assess the stage components of this model. METHODS The stage components of the NCM were assessed among adult psychiatric inpatients (N = 223; listwise N = 85) aged 18-65 years old and admitted for suicidal ideation or attempts. Suicidal outcomes were assessed at one month follow-up. Structural equation modeling (SEM) was used to assess the model and its prediction of prospective suicidal outcomes. RESULTS The model was supported by the SEM and proved to be a good fit for the data. Each temporal stage was significantly predicted by the precedent stage in the model and 13% of the variance in suicidal ideation and behaviors (when assessed conjointly) were explained by the model. When suicidal ideation and attempts were assessed separately, the amount of variance explained was 10.8% for suicidal ideation and 40.7% for suicidal attempts. DISCUSSION The progression from trait vulnerabilities to suicidal outcomes proposed by the NCM was supported by our findings. These findings have clinical implications in the assessment and treatment of suicide risk and will need replication with larger samples.
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Affiliation(s)
| | | | - Lauren Lloveras
- Department of Psychiatry and Behavioral Health, Mount Sinai Beth Israel Medical Center, New York City, NY, USA
| | - Timothy Wilkerson
- Department of Psychiatry and Behavioral Health, Mount Sinai Beth Israel Medical Center, New York City, NY, USA
| | - Allison Schuck
- Department of Psychiatry and Behavioral Health, Mount Sinai Beth Israel Medical Center, New York City, NY, USA
| | - Shira Barzilay
- Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | | | - David Schnur
- Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Igor Galynker
- Icahn School of Medicine at Mount Sinai, New York City, NY, USA; Adelphi University, New York City, USA
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12
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Claus C, Teismann T. Akut suizidal-affektive Störung: Ein systematisches Review. VERHALTENSTHERAPIE 2020. [DOI: 10.1159/000511922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
<b><i>Hintergrund:</i></b> Die Arbeitsgruppe um Thomas Joiner postuliert ein als <i>acute suicidal affective disturbance</i> (ASAD) bezeichnetes Syndrom, welches durch vier Symptomgruppen (Suizidabsicht, Entfremdung, Hoffnungslosigkeit, Übererregung) definiert sein soll. Ziel des vorliegenden Artikels ist, die Literatur zum ASAD-Syndrom zusammenfassend darzustellen und eine Einschätzung vorzunehmen, inwieweit tatsächlich von einem einheitlichen Syndrom ausgegangen werden kann. <b><i>Methoden:</i></b> Im Rahmen einer Literaturrecherche konnten neun Artikel identifiziert werden, die im Zeitraum von 2016 bis 2020 zum Thema publiziert wurden. <b><i>Ergebnisse und Schlussfolgerungen:</i></b> Die Befundlage unterstützt den einheitlichen Störungscharakter und die Abgrenzbarkeit der akut suizidal-affektiven Störung von anderen Störungsbildern. Die Aussagekraft der Befundlage ist dadurch eingeschränkt, dass bislang ausschließlich Querschnittsuntersuchungen durchgeführt wurden und keinerlei Befunde dazu vorliegen, ob ASAD tatsächlich suizidalem Verhalten vorausgeht.
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13
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Barzilay S, Assounga K, Veras J, Beaubian C, Bloch-Elkouby S, Galynker I. Assessment of near-term risk for suicide attempts using the suicide crisis inventory. J Affect Disord 2020; 276:183-190. [PMID: 32697697 DOI: 10.1016/j.jad.2020.06.053] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 04/17/2020] [Accepted: 06/23/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND The Suicide Crisis Syndrome (SCS) describes a pre-suicidal mental state marked by entrapment accompanied by affective disturbances, loss of cognitive control, hyperarousal and social withdrawal. This study tested the consistency and validity of the Suicide Crisis Inventory (SCI), a proposed measure of SCS severity, amongst a large, heterogeneous patient sample. METHODS The SCI was used to assess 867 adult psychiatric inpatients and outpatients. Confirmatory factor analysis, logistic regressions and area under the curve analyses (AUC) were used to examine internal structure, construct validity and predictive validity for suicide ideation, plan and attempt one-month post-assessment. RESULTS The five-factor model of the SCS demonstrated good fit and excellent internal consistency. SCI scores indicated significant associations but non-redundancy with depression, anxiety, and independence from other dimensions of psychiatric distress. SCI scores specifically predicted suicide attempts with an AUC of 0.733 and odds ratio=8.62 (p<0.001) at optimal cut-off point. SCI incremental predictive validity over and beyond suicidal ideation and attempts history reported at baseline was supported for predicting suicide attempts (β= 0.012, S.E = 0.006; p=0.046). LIMITATIONS The SCI is subject to self-report bias and does not include the SCS social withdrawal component. Follow-up assessment retention was partial (68%, n=591). CONCLUSION The SCI is validated as a tool for the assessment of the SCS intensity and of imminent suicidal behavior. The SCI is suggested as a tool that could aid both researchers and clinicians in comprehensive assessment of a pre-suicidal mental state within moderate to high-risk populations, regardless of self-report on suicidal intent.
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Affiliation(s)
- Shira Barzilay
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City, NY USA; Department of Psychiatry, Schneider Children's Medical Center of Israel, Tel Aviv University, Tel Aviv, Israel.
| | - Krystel Assounga
- Department of Psychiatry and Behavioral Health, Mount Sinai Beth Israel Medical Center, New York City, NY USA
| | - Jacqueline Veras
- Department of Psychiatry and Behavioral Health, Mount Sinai Beth Israel Medical Center, New York City, NY USA
| | - Courtnie Beaubian
- Department of Psychiatry and Behavioral Health, Mount Sinai Beth Israel Medical Center, New York City, NY USA
| | - Sarah Bloch-Elkouby
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City, NY USA
| | - Igor Galynker
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City, NY USA; Department of Psychiatry and Behavioral Health, Mount Sinai Beth Israel Medical Center, New York City, NY USA
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14
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Ying G, Cohen LJ, Lloveras L, Barzilay S, Galynker I. Multi-informant prediction of near-term suicidal behavior independent of suicidal ideation. Psychiatry Res 2020; 291:113169. [PMID: 32562934 DOI: 10.1016/j.psychres.2020.113169] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 05/29/2020] [Accepted: 05/30/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Both the Suicide Crisis Syndrome (SCS) and clinicians' emotional responses to suicidal patients are predictive of near-term suicidal behaviors. Thus, we tested predictive validity of a combination of the proposed Diagnostic and Statistical Manual SCS criteria and the Therapist Response Questionnaire Suicide Form (TRQ-SF) for near-term suicidal behavior. METHODS The presence of SCS in adult psychiatric outpatients (N=451) was assessed using relevant items from validated psychometric assessments. Clinicians completed the TRQ-SF immediately after patient intake. Suicide attempts (SA) and a combination of suicide plans and attempts (SPA) were measured at one month follow-up (N=359). RESULTS At follow-up nine patients reported having SPA and seven reported SA. Meeting the SCS criteria were associated with near-term SA (χ2=5.987, p<0.01), while high TRQ-SF scores were associated with both near-term SA (χ2=5.971, p<0.05) and SPA (χ2=7.069, p<0.01). Meeting either the SCS or having high TRQ-SF scores, but not both, was associated with near-term SA (χ2=11.893, p<0.01) and SPA (χ2=11.449, p<0.01). Incremental predictive validity over standard suicide risk factors and individual scales was demonstrated in logistic regressions. CONCLUSIONS Multi-informant risk assessment not reliant on patient self-reported ideation appear to enhance predictive power of traditional risk assessments in identifying imminent suicide risk.
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Affiliation(s)
- Gelan Ying
- Mount Sinai Beth Israel Department of Psychiatry.
| | - Lisa J Cohen
- Mount Sinai Beth Israel Department of Psychiatry
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15
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Ballard ED, Farmer CA, Shovestul B, Voort JV, Machado-Vieira R, Park L, Merikangas KR, Zarate CA. Symptom trajectories in the months before and after a suicide attempt in individuals with bipolar disorder: A STEP-BD study. Bipolar Disord 2020; 22:245-254. [PMID: 31737973 PMCID: PMC7289321 DOI: 10.1111/bdi.12873] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES The suicide crisis is a relatively short-lived psychiatric emergency, with transient symptoms that ebb and flow around the suicide attempt. Understanding the dynamic processes of symptoms before and after suicide attempt may aid future prevention efforts. METHODS Data were drawn from the NIMH STEP-BD study, which followed 4,360 patients with bipolar disorder; a subset attempted suicide during the trial (245/4100 or 5.97% of the sample eligible for analysis). This analysis focused on change in suicidal ideation (SI) in the 120 days before and 120 days after suicide attempt; similar analyses were conducted for other depressive symptoms. Generalized linear mixed models with a two-piece linear function of time corresponding to pre- and post-suicide attempt trends were used. RESULTS SI ratings from 216 individuals were analyzed (n = 1,231 total; n = 395 pre-attempt, n = 126 circa-attempt, n = 710 post-attempt) and compared to data from a matched sample of 648 non-attempters. SI worsened in the 120 days pre-attempt but improved afterwards, reaching non-attempter levels by 90 days post-attempt. A similar pattern was found for other depressive symptoms, including depressed mood, loss of interest, guilt, and self-esteem. Pre/post differences in tension/activating symptoms of depression-anxiety, agitation, and irritability-were less pronounced and more time-limited. CONCLUSIONS The suicide crisis is dynamic, and the days before and after suicide attempt may be particularly critical. The findings extend previous research on proximal symptoms of suicide and underscore that some SI and affective/cognitive symptoms of depression can remain elevated up to 90 days post-attempt in individuals with bipolar disorder.
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Affiliation(s)
- Elizabeth D. Ballard
- Experimental Therapeutics & Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Cristan A. Farmer
- Experimental Therapeutics & Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Bridget Shovestul
- Experimental Therapeutics & Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | | | - Rodrigo Machado-Vieira
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Science Center, Houston, TX, USA
| | - Lawrence Park
- Experimental Therapeutics & Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Kathleen R. Merikangas
- Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental Health, Bethesda, MD, USA
| | - Carlos A. Zarate
- Experimental Therapeutics & Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
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Calati R, Nemeroff CB, Lopez-Castroman J, Cohen LJ, Galynker I. Candidate Biomarkers of Suicide Crisis Syndrome: What to Test Next? A Concept Paper. Int J Neuropsychopharmacol 2019; 23:192-205. [PMID: 31781761 PMCID: PMC7171927 DOI: 10.1093/ijnp/pyz063] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 11/25/2019] [Accepted: 11/27/2019] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND There has been increasing interest in both suicide-specific diagnoses within the psychiatric nomenclature and related biomarkers. Because the Suicide Crisis Syndrome-an emotional crescendo of several interrelated symptoms-seems to be promising for the identification of individuals at risk of suicide, the aim of the present paper is to review the putative biological underpinnings of the Suicide Crisis Syndrome symptoms (entrapment, affective disturbance, loss of cognitive control, hyperarousal, social withdrawal). METHODS A PubMed literature search was performed to identify studies reporting a link between each of the 5 Suicide Crisis Syndrome symptoms and biomarkers previously reported to be associated with suicidal outcomes. RESULTS Disturbances in the hypothalamic-pituitary-adrenal axis, with dysregulated corticotropin-releasing hormone and cortisol levels, may be linked to a sense of entrapment. Affective disturbance is likely mediated by alterations in dopaminergic circuits involved in reward and antireward systems as well as endogenous opioids. Loss of cognitive control is linked to altered neurocognitive function in the areas of executive function, attention, and decision-making. Hyperarousal is linked to autonomic dysregulation, which may be characterized by a reduction in both heart rate variability and electrodermal activity. Social withdrawal has been associated with oxytocin availability. There is also evidence that inflammatory processes may contribute to individual Suicide Crisis Syndrome symptoms. CONCLUSION The Suicide Crisis Syndrome is a complex syndrome that is likely the consequence of distinct changes in interconnected neural, neuroendocrine, and autonomic systems. Available clinical and research data allow for development of empirically testable hypotheses and experimental paradigms to scrutinize the biological substrates of the Suicide Crisis Syndrome.
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Affiliation(s)
- Raffaella Calati
- Department of Psychiatry, Mount Sinai Beth Israel, New York, New York,Icahn School of Medicine at Mount Sinai, New York, New York,Department of Psychology, University of Milan-Bicocca, Milan, Italy,Department of Adult Psychiatry, Nîmes University Hospital, Nîmes, France,Correspondence: Raffaella Calati, PsyD, PhD, Department of Psychology, University of Milan-Bicocca, Piazza dell’Ateneo Nuovo 1, 20126, Milan, Italy ()
| | - Charles B Nemeroff
- Department of Psychiatry, University of Texas Dell Medical School, Austin, Texas
| | - Jorge Lopez-Castroman
- Department of Adult Psychiatry, Nîmes University Hospital, Nîmes, France,INSERM, University of Montpellier, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France
| | - Lisa J Cohen
- Department of Psychiatry, Mount Sinai Beth Israel, New York, New York,Icahn School of Medicine at Mount Sinai, New York, New York
| | - Igor Galynker
- Department of Psychiatry, Mount Sinai Beth Israel, New York, New York,Icahn School of Medicine at Mount Sinai, New York, New York
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Yaseen ZS, Hawes M, Barzilay S, Galynker I. Predictive Validity of Proposed Diagnostic Criteria for the Suicide Crisis Syndrome: An Acute Presuicidal State. Suicide Life Threat Behav 2019; 49:1124-1135. [PMID: 30073686 DOI: 10.1111/sltb.12495] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 07/13/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Determining imminent risk of suicide continues to challenge psychiatrists. To this end, we test the clinical utility of a proposed set of diagnostic criteria for the suicide crisis syndrome (SCS) for prediction of imminent suicidal thoughts and behaviors prospectively. METHOD One hundred and seventy individuals hospitalized for suicidal thoughts and behaviors (STB) were evaluated within 72 hr of admission with measures assessing symptoms of the proposed SCS, history of STB, current ideation, and depression severity. Four-eight weeks following discharge, STB were reassessed. Associations between SCS and postdischarge attempts were examined using chi-square and logistic regression analyses. The receiver operator characteristic analysis was used to test the optimal number of symptoms required to meet proposed SCS criteria. RESULTS The syndrome was maximally informative about short-term risk of postdischarge suicide behavior when all criteria were met. The syndrome conferred a sevenfold increase in risk of postdischarge suicide attempt, and significantly improved prediction by standard risk factors, which was null to limited. CONCLUSIONS The SCS diagnostic criteria are supported and appear to describe a clinically meaningful syndrome in a high-risk population. Assessment of SCS may meaningfully improve clinical assessment of imminent suicide risk. Further study is needed to better understand the syndrome and its applicability in low-risk populations.
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Affiliation(s)
- Zimri S Yaseen
- Department of Psychiatry, Mount Sinai Beth Israel, New York, NY, USA
| | - Mariah Hawes
- Department of Psychiatry, Mount Sinai Beth Israel, New York, NY, USA
| | - Shira Barzilay
- Department of Psychiatry, Mount Sinai Beth Israel, New York, NY, USA
| | - Igor Galynker
- Department of Psychiatry, Mount Sinai Beth Israel, New York, NY, USA
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18
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Schuck A, Calati R, Barzilay S, Bloch-Elkouby S, Galynker I. Suicide Crisis Syndrome: A review of supporting evidence for a new suicide-specific diagnosis. BEHAVIORAL SCIENCES & THE LAW 2019; 37:223-239. [PMID: 30900347 DOI: 10.1002/bsl.2397] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 12/21/2018] [Accepted: 12/22/2018] [Indexed: 06/09/2023]
Abstract
Suicide is a major public health problem, and suicide rates are still on the rise. Current strategies for identifying individuals at risk for suicide, such as the use of a patient's self-reported suicidal ideation or evidence of past suicide attempts, have not been sufficient in reducing suicide rates. Recently, research groups have been focused on determining the acute mental state preceding a suicide attempt. The development of an acute suicidal diagnosis, the Suicide Crisis Syndrome (SCS), is aimed at capturing this state to better treat individuals. The SCS has five main evidence-based components-entrapment, affective disturbance, loss of cognitive control, hyperarousal, and social withdrawal. The SCS may provide clinicians with the ability to identify individuals who are experiencing an acute pre-suicidal mental state, regardless of their self-reported suicidal ideation. Future research leading to the incorporation of this diagnosis into clinical practice could improve the quality of care and reduce the personal, societal, and legal burden of suicide.
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Affiliation(s)
- Allison Schuck
- Department of Psychiatry, Mount Sinai Beth Israel, New York, NY, USA
| | - Raffaella Calati
- Department of Psychiatry, Mount Sinai Beth Israel, New York, NY, USA
| | - Shira Barzilay
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Igor Galynker
- Department of Psychiatry, Mount Sinai Beth Israel, New York, NY, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Cohen LJ, Gorman B, Briggs J, Jeon ME, Ginsburg T, Galynker I. The Suicidal Narrative and Its Relationship to the Suicide Crisis Syndrome and Recent Suicidal Behavior. Suicide Life Threat Behav 2019; 49:413-422. [PMID: 29397571 DOI: 10.1111/sltb.12439] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 10/30/2017] [Indexed: 11/28/2022]
Abstract
In this study, we introduce the construct of the suicidal narrative, a hypothetical personal narrative linked to imminent suicide, and explore its relationship to near-term suicidal risk and the suicide crisis syndrome (SCS). Psychiatric outpatients (N = 289) were administered the Columbia Suicide-Severity Rating Scale (C-SSRS), Suicide Crisis Inventory (SCI), and Suicide Narrative Inventory (SNI), a novel instrument combining the documented risk factors of Thwarted Belongingness, Perceived Burdensomeness, Humiliation, Social Defeat, Goal Disengagement, and Goal Reengagement. Dimensional measures of past month, lifetime, and past suicidal phenomena, incorporating ideation and behavior, were calculated from the C-SSRS. Structural equation modeling was used to explore the interaction among variables. Factor analysis of the SNI yielded two orthogonal factors, termed Interpersonal and Goal Orientation. The former factor was comprised of Perceived Burdensomeness, Social Defeat, Humiliation, and Thwarted Belongingness, the latter of Goal Disengagement and Goal Reengagement. The Interpersonal factor correlated with both SCS severity and suicidal phenomena in each time frame and the Goal Orientation factor with no other variable. As hypothesized, the proposed model was significant for the past month only. Our findings support the construct of the suicidal narrative and its function as a near-term suicidal risk factor.
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Affiliation(s)
- Lisa Janet Cohen
- Department of Psychiatry, Mount Sinai Beth Israel, New York, NY, USA
| | - Bernard Gorman
- Department of Psychology, Adelphi University, Garden City, NY, USA
| | - Jessica Briggs
- Touro College of Osteopathic Medicine, New York, NY, USA
| | - Min Eun Jeon
- Department of Psychiatry, Mount Sinai Beth Israel, New York, NY, USA
| | - Tal Ginsburg
- Department of Psychiatry, Mount Sinai Beth Israel, New York, NY, USA
| | - Igor Galynker
- Department of Psychiatry, Mount Sinai Beth Israel, New York, NY, USA
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20
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Hawes M, Galynker I, Barzilay S, Yaseen ZS. Anhedonia and suicidal thoughts and behaviors in psychiatric outpatients: The role of acuity. Depress Anxiety 2018; 35:1218-1227. [PMID: 30107636 DOI: 10.1002/da.22814] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 06/16/2018] [Accepted: 07/01/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Anhedonia-impairment related to the experience of pleasure-has been identified as a potential risk factor for suicide, with some mixed findings. The current study sought to clarify the role of acuity of anhedonia in the relationship between anhedonia and suicidal thoughts and behaviors by comparing acutely and chronically anhedonic subjects on severity of suicidal ideation (SI) and suicide attempt (SA) history. METHODS Psychiatric outpatients (N = 395) were administered the Columbia Suicide Severity Rating Scale, the Beck Scale for Suicidal Ideation and a modified version of the Snaith-Hamilton Pleasure Scale (SHPS); SI measures were readministered at a 1-month follow-up (N = 289, 73%). Participants were classified as acutely anhedonic, chronically anhedonic and nonanhedonic based on their responses to the SHPS at initial assessment. RESULTS Controlling for symptoms of anxiety and depression, acute anhedonia was cross-sectionally and prospectively associated with greater severity of SI compared to the nonanhedonic group; no differences in severity of SI were found between the chronically anhedonic and nonanhedonic group at either time point. Anhedonia grouping was not associated with SA history. CONCLUSION Changes in capacity to experience pleasure may be more informative of near-term SI than typically low pleasure levels. Future investigation should focus on the relationship between acute anhedonia and imminent suicidal behavior.
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Affiliation(s)
- Mariah Hawes
- Department of Psychiatry, Mount Sinai Beth Israel Medical Center, New York, New York
| | - Igor Galynker
- Department of Psychiatry, Mount Sinai Beth Israel Medical Center, New York, New York
| | - Shira Barzilay
- Department of Psychiatry, Mount Sinai Beth Israel Medical Center, New York, New York
| | - Zimri S Yaseen
- Department of Psychiatry, Mount Sinai Beth Israel Medical Center, New York, New York
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21
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Mellentin A, Stenager EN, Stenager E. Preventing suicidal behavior in patients with multiple sclerosis: a scoping review. Expert Rev Neurother 2018; 18:945-952. [PMID: 30451039 DOI: 10.1080/14737175.2018.1549990] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Suicidal behavior is a relatively rare occurrence among patients with multiple sclerosis (MS). Nonetheless, it is important to identify and be aware of the constituting risk factors to prevent suicidal behavior among vulnerable patients. Areas covered: This scoped review will shortly outline well-known biological and psychosocial risk factors for suicidal behavior among MS patients and suggest preventive initiatives. The preventive strategies should include a close monitoring of MS pharmacotherapy to prevent progression, and awareness and early identification of psychosocial risk factors across a variety of heathcare and social instances the patient may encounter during their life with the disease. The staff in these instances should be educated in detecting the MS patients at increased risk and refer them to relevant healthcare instances, including the general practitioner, neurologists, psychiatrist, etc. In addition, referral to social instances to support educational, vocational, and home environment to the state of the disease is of utmost importance. Expert commentary: Enhancing quality of life for as long as possible by these means may be held to reduce the risk for psychosocial problems and hence suicidal behavior.
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Affiliation(s)
- Angelina Mellentin
- a Unit for Psychiatric Research, Department of Clinical Research , University of Southern Denmark , Odense , Denmark.,b Unit for Psychiatric Research, Institute of Regional Health Services Research , University of Southern Denmark , Aabenraa , Denmark
| | - Elsebeth Nylev Stenager
- d Department of Regional Health Research , University of Southern Denmark , Odense , Denmark
| | - Egon Stenager
- c Multiple sclerosis clinic of Southern Jutland (Sønderborg, Esbjerg, Kolding) , Hospital of Southern Jutland , Aabenraa , Denmark.,d Department of Regional Health Research , University of Southern Denmark , Odense , Denmark
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Goldblatt MJ, Herbstman B, Schechter M, Ronningstam E. John Terry Maltsberger, American Psychoanalyst: Contributions to the Development of Studies of Suicide and Self-attack. J Am Psychoanal Assoc 2018; 66:861-882. [PMID: 30384787 DOI: 10.1177/0003065118801596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
John Terry Maltsberger (1933-2016) was an American psychoanalyst who greatly influenced studies of the suicidal patient, and a suicidologist whose contributions significantly impacted psychoanalysis. Through his devotion to the understanding and treatment of suicidal people he exerted a major influence in both areas. Throughout a long and productive career, Maltsberger focused on an uncomfortable area of the psyche, that sphere that impels the attack on the self. His position in psychoanalysis stands out for his early emphasis on the patient's internal subjective experience and the dynamics of the therapeutic engagement. He had a broad range of knowledge and interests beyond psychoanalysis and was able to integrate perspectives from empirical studies with his empathic understanding of clinical material and a striking ability to make complex and impenetrable intrapsychic processes lucidly understandable.
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Cohen LJ, Ardalan F, Yaseen Z, Galynker I. Suicide Crisis Syndrome Mediates the Relationship Between Long-term Risk Factors and Lifetime Suicidal Phenomena. Suicide Life Threat Behav 2018; 48:613-623. [PMID: 28833408 DOI: 10.1111/sltb.12387] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 05/19/2017] [Indexed: 11/27/2022]
Abstract
In recent years, there has been growing attention to the distinction between acute and long-term suicidal risk factors. We have previously characterized an acute, negative affect state, termed the suicide crisis syndrome (SCS), as a marker of near-term suicidal risk. Here, we test whether documented long-term risk factors (i.e., trait vulnerabilities), including perfectionism, impulsivity, chronic substance abuse, insecure attachment, poor social support, and childhood trauma, associate to suicidal phenomena through a pathway of the SCS. A sample of 207 psychiatric inpatients were administered a battery of eight scales, including the Suicide Trigger Scale (STS-3) as a measure of the SCS. While both STS-3 and all trait vulnerabilities were associated with lifetime suicidal ideation and attempts, only STS-3 was related to pre-admission suicide attempts. The STS-3 significantly mediated the effect of each trait vulnerability on lifetime suicidal phenomena (combining ideation and behavior), with the proportion of mediating effect ranging from .29 to .56. Reverse mediation analyses were only significant for insecure attachment, supporting a largely unidirectional mediation effect. The SCS appears to serve as an acute risk factor for suicidal behavior in psychiatric inpatients and may act as a mechanism by which long-term risk factors increase suicidal risk.
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Affiliation(s)
| | | | - Zimri Yaseen
- Psychiatry, Mount Sinai Beth Israel, New York, NY, USA
| | - Igor Galynker
- Psychiatry, Mount Sinai Beth Israel, New York, NY, USA
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Li S, Yaseen ZS, Kim HJ, Briggs J, Duffy M, Frechette-Hagan A, Cohen LJ, Galynker II. Entrapment as a mediator of suicide crises. BMC Psychiatry 2018; 18:4. [PMID: 29310622 PMCID: PMC5759206 DOI: 10.1186/s12888-018-1587-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 01/01/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Prior research has validated the construct of a suicide crisis syndrome (SCS), a specific psychological state that precedes and may precipitate suicidal behavior. The feeling of entrapment is a central concept of the SCS as well as of several other recent models of suicide. However, its exact relationship with suicidality is not fully understood. In efforts to clarify the exact role of entrapment in the suicidal process, we have examined if entrapment mediates the relationship of other components of the SCS, including ruminative flooding, panic-dissociation, fear of dying and emotional pain, with suicidal ideation (SI) in recently hospitalized psychiatric inpatients. METHODS The Suicide Crisis Inventory (SCI) and Beck Scale for Suicidal Ideation (BSS) were administered to 200 high-risk adult psychiatric inpatients hospitalized following SI or suicide attempt, assessing SCS and SI levels at admission, respectively. The possible mediation effects of entrapment on the relationship between the other components of the SCS and SI at admission were evaluated. RESULTS Entrapment significantly and fully mediated the relationship of ruminative flooding, panic-dissociation, and fear of dying with SI, with no direct relationships between these variables and SI reaching statistical significance. Further, no reverse mediation relationships between these variables and SI were found, indicating that the mediation effects of entrapment were unidirectional. While entrapment did mediate the association between emotional pain and SI, the direct relationship between emotional pain and SI was also significant. Moreover, in reverse mediational analysis, emotional pain was a partial mediator of the relationship between entrapment and SI. CONCLUSION Entrapment and emotional pain may have a more direct association with SI than the other components of the SCS, including ruminative flooding, panic-dissociation, and fear of dying, the effects of which are mediated by the former. This suggests entrapment and emotional pain may represent key symptomatic targets for intervention in acutely suicidal individuals. Further research is needed to determine the relationship of these constructs to suicidal behavior.
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Affiliation(s)
- Shuang Li
- Department of Psychiatry, Beth Israel Medical Center NY, 1st Avenue and 15th Street, New York, NY 10003 USA
| | - Zimri S. Yaseen
- Department of Psychiatry, Beth Israel Medical Center NY, 1st Avenue and 15th Street, New York, NY 10003 USA
| | - Hae-Joon Kim
- Department of Psychiatry, Beth Israel Medical Center NY, 1st Avenue and 15th Street, New York, NY 10003 USA
| | - Jessica Briggs
- Department of Psychiatry, Beth Israel Medical Center NY, 1st Avenue and 15th Street, New York, NY 10003 USA
| | - Molly Duffy
- Department of Psychiatry, Beth Israel Medical Center NY, 1st Avenue and 15th Street, New York, NY 10003 USA
| | - Anna Frechette-Hagan
- Department of Psychiatry, Beth Israel Medical Center NY, 1st Avenue and 15th Street, New York, NY 10003 USA
| | - Lisa J. Cohen
- Department of Psychiatry, Beth Israel Medical Center NY, 1st Avenue and 15th Street, New York, NY 10003 USA
| | - Igor I. Galynker
- Department of Psychiatry, Beth Israel Medical Center NY, 1st Avenue and 15th Street, New York, NY 10003 USA
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Attachment style and suicide behaviors in high risk psychiatric inpatients following hospital discharge: The mediating role of entrapment. Psychiatry Res 2017; 257:309-314. [PMID: 28797954 DOI: 10.1016/j.psychres.2017.07.072] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 06/27/2017] [Accepted: 07/30/2017] [Indexed: 01/06/2023]
Abstract
Insecure attachment is associated with suicidal behavior. This relationship and its possible mediators have not been examined in high-risk psychiatric inpatients with respect to the critical high-risk period following hospital discharge. Attachment styles and perception of entrapment were assessed in 200 high-risk adult psychiatric inpatients hospitalized following suicidal ideation or suicide attempt. Suicidal behaviors were evaluated with the Columbia Suicide Severity Rating Scale at 1-2 months post-discharge. Associations between different attachment styles and suicidal behaviors were assessed and mediation of attachment effects by entrapment was modeled. Fearful attachment was associated with post-discharge suicidal behavior and there was a trend-level negative association for secure attachment. In addition, entrapment mediated the relationship between fearful attachment and suicidal behavior. The current study highlights the mediating role of perceptions of entrapment in the contribution of fearful attachment to suicidal behavior in high-risk patients, suggesting entrapment as potential therapeutic target to prevent suicidal behavior in these individuals. Further research is warranted to establish the mechanisms by which entrapment experiences emerge in patients with insecure attachment styles.
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Rogers ML, Galynker I, Yaseen Z, DeFazio K, Joiner TE. An Overview and Comparison of Two Proposed Suicide-Specific Diagnoses: Acute Suicidal Affective Disturbance and Suicide Crisis Syndrome. Psychiatr Ann 2017. [DOI: 10.3928/00485713-20170630-01] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Galynker I, Yaseen ZS, Cohen A, Benhamou O, Hawes M, Briggs J. Prediction of suicidal behavior in high risk psychiatric patients using an assessment of acute suicidal state: The suicide crisis inventory. Depress Anxiety 2017; 34:147-158. [PMID: 27712028 DOI: 10.1002/da.22559] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 08/24/2016] [Accepted: 09/04/2016] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND We have developed the Suicide Crisis Inventory (SCI) to evaluate the intensity of the Suicidal Crisis Syndrome, an acute state hypothesized to precede suicide attempt. The psychometric properties of the SCI, including predictive validity for suicidal behavior (SB), were assessed. METHODS Adult psychiatric patients (n = 201) hospitalized for high suicide risk were assessed. Logistic regression models assessed the SCI's predictive validity for SB in the 4-8 weeks following hospital discharge and its incremental predictive validity over traditional risk factors (n = 137, 64% f/u rate). Internal structure, reliability, convergent and discriminant validity, and state versus trait properties were also assessed. RESULTS The SCI had excellent internal consistency (Cronbach's α 0.970). The SCI total score at discharge predicted short-term SB with 64% sensitivity 88% specificity (OR = 13, P = .003) at its optimal cut score. In a test of its incremental predictive validity, SCI total score at discharge improved prediction of SB over traditional risk factors (Chi-squared 5.597, P = .024, model P = .001), with AOR 2.02 (P = .030). The SCI admission versus discharge test-retest reliability and score distributions showed it to be an acute state measure. CONCLUSION The SCI was predictive of future SB in high-risk psychiatric inpatients during the crucial weeks following their hospital discharge. Further validation in diverse patient populations is needed.
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Affiliation(s)
- Igor Galynker
- Department of Psychiatry, Mount Sinai Beth Israel, New York, NY, USA
| | - Zimri S Yaseen
- Department of Psychiatry, Mount Sinai Beth Israel, New York, NY, USA
| | - Abigail Cohen
- Department of Psychiatry, Mount Sinai Beth Israel, New York, NY, USA
| | - Ori Benhamou
- Department of Psychiatry, Mount Sinai Beth Israel, New York, NY, USA
| | - Mariah Hawes
- Department of Psychiatry, Mount Sinai Beth Israel, New York, NY, USA
| | - Jessica Briggs
- Department of Psychiatry, Mount Sinai Beth Israel, New York, NY, USA
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Hawes M, Yaseen Z, Briggs J, Galynker I. The Modular Assessment of Risk for Imminent Suicide (MARIS): A proof of concept for a multi-informant tool for evaluation of short-term suicide risk. Compr Psychiatry 2017; 72:88-96. [PMID: 27771563 DOI: 10.1016/j.comppsych.2016.10.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 09/15/2016] [Accepted: 10/04/2016] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND To date, no diagnostic tool has demonstrated clinical value for the assessment of short-term suicide risk among high-risk individuals. To this end we have developed the Modular Assessment of Risk for Imminent Suicide (MARIS), a modular patient and clinician informed risk evaluation instrument. Here we assess its predictive validity for suicidal behavior (SB) in psychiatric patients following discharge from an inpatient unit. METHODS The MARIS and a psychological test battery were administered to 136 adult psychiatric patients hospitalized for high risk of suicide. Eighty-six participants had complete data at discharge and 59 (69.8%) were reached for follow-up. Logistic regressions were used to assess the predictive validity of the MARIS for SB over the 4-8weeks following hospital discharge and its incremental predictive validity over standard risk factors. RESULTS Patients who exhibited SB in the period between initial assessment and follow-up had significantly higher MARIS scores. ROC analysis indicated good sensitivity and specificity of MARIS in identifying risk (OR=19). Further, MARIS total score significantly improved predictive validity by the standard risk factors when added to a model comprising global depression severity, hopelessness, and lifetime number of suicide attempts, and was the only factor that approached independent significance. CONCLUSION The MARIS appears to be a practical and effective tool for detecting short-term suicide risk following hospital discharge, supporting the validity of modular multi-informant approach to suicide risk evaluation. Replication of these findings and further investigation of the applications of such an approach are warranted.
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Affiliation(s)
- Mariah Hawes
- Mount Sinai Beth Israel, Department of Psychiatry, 317 E 17th St, New York, NY 10003, USA
| | - Zimri Yaseen
- Mount Sinai Beth Israel, Department of Psychiatry, 317 E 17th St, New York, NY 10003, USA
| | - Jessica Briggs
- Mount Sinai Beth Israel, Department of Psychiatry, 317 E 17th St, New York, NY 10003, USA
| | - Igor Galynker
- Mount Sinai Beth Israel, Department of Psychiatry, 317 E 17th St, New York, NY 10003, USA.
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Ntountoulaki E, Guthrie E, Kotsis K, Paika V, Tatsioni A, Tomenson B, Fountoulakis KN, Carvalho AF, Hyphantis T. Double RASS cutpoint accurately diagnosed suicidal risk in females with long-term conditions attending the emergency department compared to their male counterparts. Compr Psychiatry 2016; 69:193-201. [PMID: 27423361 DOI: 10.1016/j.comppsych.2016.06.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Revised: 05/29/2016] [Accepted: 06/11/2016] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Suicidal risk is often unrecognized in emergency department (ED). We aimed to assess its prevalence in patients with long-term conditions (LTCs) attending an ED and to test whether gender differences influence suicidal risk assessment, using the diagnostic accuracy properties of the Risk Assessment Suicidality Scale (RASS). METHODS The RASS was administered to 349 patients with diabetes, COPD and rheumatic diseases visiting an ED. The MINI interview was used as the criterion standard. ROC curve analysis was performed to determine the optimal RASS cutpoint for suicidal risk separately for males and females. Somatic (PHQ-15) and depressive (PHQ-9) symptoms were also assessed and factors associated with suicidal risk across gender were determined in hierarchical regression models. RESULTS The prevalence of suicidal risk according to the MINI was 22.9%; 16.6% of patients were at low, 5.1% at moderate, and 0.9% at high risk. At an optimal cutpoint of 270, RASS had 81.3% sensitivity and 81.8% specificity. The optimal RASS cutpoint for females (340) was double the cutpoint for males (175). Somatic symptom burden was associated with suicidal risk in both sexes but it became non-significant after depressive symptoms were taken into account; suicidal risk was also associated with history of depression in females and lower income in males. CONCLUSION There is a high prevalence of suicidal risk in patients with LTCs attending the ED. As the optimal RASS cutpoint for females was double the cutpoint for males, clinicians should bear in mind gender differences when assessing for suicidal risk in the ED.
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Affiliation(s)
- Elisavet Ntountoulaki
- Department of Psychiatry, Division of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Elspeth Guthrie
- Psychiatry Research Group, Medical School, University of Manchester, Manchester, UK
| | - Konstantinos Kotsis
- Department of Psychiatry, Division of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Vassiliki Paika
- Department of Psychiatry, Division of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Athina Tatsioni
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Barbara Tomenson
- Psychiatry Research Group, Medical School, University of Manchester, Manchester, UK
| | - Konstantinos N Fountoulakis
- Third Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Andre F Carvalho
- Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil
| | - Thomas Hyphantis
- Department of Psychiatry, Division of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece.
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Galynker I, Yaseen ZS, Briggs J, Hayashi F. Attitudes of acceptability and lack of condemnation toward suicide may be predictive of post-discharge suicide attempts. BMC Psychiatry 2015; 15:87. [PMID: 25884153 PMCID: PMC4403982 DOI: 10.1186/s12888-015-0462-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 03/30/2015] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Suicide attempts (SA) after psychiatric hospitalization continue to be a major cause of morbidity. Implicit measures may enhance our ability to assess suicide risk. In this context, we describe the first use of the Suicide Opinion Questionnaire (SOQ) to identify post-discharge suicide attempters. METHODS Adult psychiatric inpatients admitted for suicidality (N = 91) were administered a battery of measures including the SOQ, and forty were reached and reassessed for SA at two months post-discharge. Exploratory factor analysis (EFA) on items associated with suicidality was performed to identify latent constructs. Linear discriminant analysis (LDA) was used to optimize factor combination for suicide identification. Results were compared with explicit measures of suicidality, and logistic regression was used to control for other risk factors. Finally, a simplified 9-item scale was derived from the results and its performance compared to that of the linear discriminant function. RESULTS Twenty items differed between patients with and without SA at intake or follow-up. EFA on these identified two factors: suicide attempters indicated greater acceptability and less moral condemnation of suicide. The LDA-derived discriminant function and 9-item scale was significantly sensitive and specific for post-discharge SA. CONCLUSIONS Attitudes of acceptability and lack of condemnation toward suicide may constitute an implicit measure of suicidality that could contribute to risk assessment in a high-risk population.
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Affiliation(s)
- Igor Galynker
- Department of Psychiatry and Behavioral Sciences, Mount Sinai Beth Israel Medical Center, 1st Avenue @ 16th Street, 9-Fierman, New York, NY, 10003, USA.
| | - Zimri S Yaseen
- Department of Psychiatry and Behavioral Sciences, Mount Sinai Beth Israel Medical Center, 1st Avenue @ 16th Street, 9-Fierman, New York, NY, 10003, USA.
| | - Jessica Briggs
- Department of Psychiatry and Behavioral Sciences, Mount Sinai Beth Israel Medical Center, 1st Avenue @ 16th Street, 9-Fierman, New York, NY, 10003, USA.
| | - Fumitaka Hayashi
- Department of Psychiatry and Behavioral Sciences, Mount Sinai Beth Israel Medical Center, 1st Avenue @ 16th Street, 9-Fierman, New York, NY, 10003, USA.
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Rappaport LM, Moskowitz DS, Galynker I, Yaseen ZS. Panic symptom clusters differentially predict suicide ideation and attempt. Compr Psychiatry 2014; 55:762-9. [PMID: 24439632 DOI: 10.1016/j.comppsych.2013.10.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Revised: 10/07/2013] [Accepted: 10/09/2013] [Indexed: 10/25/2022] Open
Abstract
Increasingly strong evidence links anxiety disorders in general and panic attacks in particular to suicidality. The underlying causes and specifics of this relation, however, remain unclear. The present article sought to begin addressing this question by clarifying the association between panic symptoms and suicidality. Data were sampled from the NESARC epidemiological data set from the US and analyzed as four independently, randomly selected subsets of 1000 individuals using structural equation modeling analyses and replicating results across samples. Evidence is presented for four symptom clusters (cognitive symptoms, respiratory distress, symptoms of alpha and beta adrenergic activation) and the differential association of each with suicidal ideation and attempts. Symptoms of alpha adrenergic activation predicted prior suicide attempt whereas cognitive symptoms predicted prior suicidal ideation. These findings were independent of comorbid major depressive disorder. It is suggested that assessment of suicide risk in the community includes the presentation of cognitive symptoms and symptoms related to alpha adrenergic activation.
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Affiliation(s)
| | - D S Moskowitz
- Department of Psychology, McGill University, Montreal, QC, Canada
| | - Igor Galynker
- Department of Psychiatry, Beth Israel Medical Center, New York, NY
| | - Zimri S Yaseen
- Department of Psychiatry, Beth Israel Medical Center, New York, NY
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Yaseen ZS, Kopeykina I, Gutkovich Z, Bassirnia A, Cohen LJ, Galynker II. Predictive validity of the Suicide Trigger Scale (STS-3) for post-discharge suicide attempt in high-risk psychiatric inpatients. PLoS One 2014; 9:e86768. [PMID: 24466229 PMCID: PMC3897755 DOI: 10.1371/journal.pone.0086768] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 12/17/2013] [Indexed: 11/19/2022] Open
Abstract
Background The greatly increased risk of suicide after psychiatric hospitalization is a critical problem, yet we are unable to identify individuals who would attempt suicide upon discharge. The Suicide Trigger Scale v.3 (STS-3), was designed to measure the construct of an affective ‘suicide trigger state’ hypothesized to precede a suicide attempt (SA). This study aims to test the predictive validity of the STS-3 for post-discharge SA on a high-risk psychiatric-inpatient sample. Methods The STS-3, and a psychological test battery measuring suicidality, mood, impulsivity, trauma history, and attachment style were administered to 161 adult psychiatric patients hospitalized following suicidal ideation (SI) or SA. Receiver Operator Characteristic and logistic regression analyses were used to assess prediction of SA in the 6-month period following discharge from hospitalization. Results STS-3 scores for the patients who made post-discharge SA followed a bimodal distribution skewed to high and low scores, thus a distance from median transform was applied to the scores. The transformed score was a significant predictor of post-discharge SA (AUC 0.731), and a subset of six STS-3 scale items was identified that produced improved prediction of post-discharge SA (AUC 0.814). Scores on C-SSRS and BSS were not predictive. Patients with ultra-high (90th percentile) STS-3 scores differed significantly from ultra-low (10th percentile) scorers on measures of affective intensity, depression, impulsiveness, abuse history, and attachment security. Conclusion STS-3 transformed scores at admission to the psychiatric hospital predict suicide attempts following discharge among the high-risk group of suicidal inpatients. Patients with high transformed scores appear to comprise two clinically distinct groups; an impulsive, affectively intense, fearfully attached group with high raw STS-3 scores and a low-impulsivity, low affect and low trauma-reporting group with low raw STS-3 scores. These groups may correspond to low-plan and planned suicide attempts, respectively, but this remains to be established by future research.
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Affiliation(s)
- Zimri S. Yaseen
- Beth Israel Medical Center, New York, New York, United States of America
- * E-mail:
| | - Irina Kopeykina
- Beth Israel Medical Center, New York, New York, United States of America
| | - Zinoviy Gutkovich
- St. Luke's Roosevelt Hospital, New York, New York, United States of America
| | - Anahita Bassirnia
- Beth Israel Medical Center, New York, New York, United States of America
| | - Lisa J. Cohen
- Beth Israel Medical Center, New York, New York, United States of America
| | - Igor I. Galynker
- Beth Israel Medical Center, New York, New York, United States of America
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Yaseen ZS, Chartrand H, Mojtabai R, Bolton J, Galynker II. Fear of dying in panic attacks predicts suicide attempt in comorbid depressive illness: prospective evidence from the National Epidemiological Survey on Alcohol and Related Conditions. Depress Anxiety 2013; 30:930-9. [PMID: 23281011 DOI: 10.1002/da.22039] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Revised: 11/07/2012] [Accepted: 11/14/2012] [Indexed: 11/08/2022] Open
Abstract
CONTEXT As a group, comorbid anxiety disorders among depressed persons have consistently been found to increase risk of suicide attempt (SA). Growing evidence supports the link between panic attacks (PAs) and suicidality, but prospective evidence is limited and the nature of the linkage remains unclear. The positive-feedback model of suicide suggests that PAs eliciting catastrophic cognitions may drive SA. OBJECTIVE To prospectively examine the relationship between PAs, panic symptoms and suicidality in individuals meeting DSM-IV criteria for past-year major depressive episodes in a large epidemiological study. METHODS In data on 2,864 participants of the National Epidemiological Survey on Alcohol and Related Conditions (NESARC) wave 1 and 2 surveys with depressive disorders, the associations of PAs and panic symptoms with subsequent suicidal ideation (SI) and SAs were assessed using logistic regression. RESULTS Past-year PAs in wave 1 significantly increased odds for subsequent SI and attempt in the 3-year follow-up interval; however, in multivariate analyses, PAs were not a significant predictor, but PAs featuring fear of dying were. Further, among subjects with PAs, fear of dying during a PA increased the odds of subsequent SA sevenfold, even after controlling for comorbid disorders, demographic factors, and other PA symptoms. CONCLUSION PAs characterized by prominent morbid catastrophic cognitions may mediate the transition to SIs and SAs in subjects with depressive episodes. Presence of these symptoms in clinical settings may serve as a warning sign for future suicidality.
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Affiliation(s)
- Zimri S Yaseen
- Department of Psychiatry and Behavioral Sciences, Beth Israel Medical Center, First Avenue at Sixteenth Street, New York
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Yaseen ZS, Briggs J, Kopeykina I, Orchard KM, Silberlicht J, Bhingradia H, Galynker II. Distinctive emotional responses of clinicians to suicide-attempting patients--a comparative study. BMC Psychiatry 2013; 13:230. [PMID: 24053664 PMCID: PMC3851279 DOI: 10.1186/1471-244x-13-230] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 09/18/2013] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Clinician responses to patients have been recognized as an important factor in treatment outcome. Clinician responses to suicidal patients have received little attention in the literature however, and no quantitative studies have been published. Further, although patients with high versus low lethality suicidal behaviors have been speculated to represent two distinct populations, clinicians' emotional responses to them have not been examined. METHODS Clinicians' responses to their patients when last seeing them prior to patients' suicide attempt or death were assessed retrospectively with the Therapist Response/Countertransference Questionnaire, administered anonymously via an Internet survey service. Scores on individual items and subscale scores were compared between groups, and linear discriminant analysis was applied to determine the combination of items that best discriminated between groups. RESULTS Clinicians reported on patients who completed suicide, made high-lethality attempts, low-lethality attempts, or died unexpected non-suicidal deaths in a total of 82 cases. We found that clinicians treating imminently suicidal patients had less positive feelings towards these patients than for non-suicidal patients, but had higher hopes for their treatment, while finding themselves notably more overwhelmed, distressed by, and to some degree avoidant of them. Further, we found that the specific paradoxical combination of hopefulness and distress/avoidance was a significant discriminator between suicidal patients and those who died unexpected non-suicidal deaths with 90% sensitivity and 56% specificity. In addition, we identified one questionnaire item that discriminated significantly between high- and low-lethality suicide patients. CONCLUSIONS Clinicians' emotional responses to patients at risk versus not at risk for imminent suicide attempt may be distinct in ways consistent with responses theorized by Maltsberger and Buie in 1974. Prospective replication is needed to confirm these results, however. Our findings demonstrate the feasibility of using quantitative self-report methodologies for investigation of the relationship between clinicians' emotional responses to suicidal patients and suicide risk.
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Affiliation(s)
- Zimri S Yaseen
- Department of Psychiatry, Beth Israel Medical Center, New York, NY 10003, USA.
| | - Jessica Briggs
- Department of Psychiatry, Beth Israel Medical Center, New York, NY 10003, USA
| | - Irina Kopeykina
- Department of Psychiatry, Beth Israel Medical Center, New York, NY 10003, USA
| | - Kali M Orchard
- Department of Psychiatry, Beth Israel Medical Center, New York, NY 10003, USA
| | - Jessica Silberlicht
- Department of Psychiatry, Beth Israel Medical Center, New York, NY 10003, USA
| | - Hetal Bhingradia
- Department of Psychiatry, Beth Israel Medical Center, New York, NY 10003, USA
| | - Igor I Galynker
- Department of Psychiatry, Beth Israel Medical Center, New York, NY 10003, USA
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Yaseen ZS, Gilmer E, Modi J, Cohen LJ, Galynker II. Emergency room validation of the revised Suicide Trigger Scale (STS-3): a measure of a hypothesized suicide trigger state. PLoS One 2012; 7:e45157. [PMID: 23024805 PMCID: PMC3443232 DOI: 10.1371/journal.pone.0045157] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Accepted: 08/16/2012] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The Suicide Trigger Scale (STS) was designed to measure the construct of an affective 'suicide trigger state.' This study aims to extend the inpatient setting validation study of the original Suicide Trigger Scale version 2 to the revised Suicide Trigger Scale version 3 (STS-3) in an acute psychiatric emergency room setting. METHODS The 42-item STS-3 and a brief psychological test battery were administered to 183 adult psychiatric patients with suicidal ideation or attempt in the psychiatric emergency room, and re-administered to subjects at 1 year follow up. Factor analysis, linear and logistic regressions were used to examine construct structure, divergent and convergent validity, and construct validity, respectively. RESULTS The STS-3 demonstrated strong internal consistency (Cronbach's alpha 0.94). Factor analysis yielded a three-factor solution, which explained 43.4% of the variance. Principal axis factor analysis was used to identify three reliable subscales: Frantic Hopelessness, Ruminative Flooding, and Near-Psychotic Somatization (Cronbach's alphas 0.90, 0.80, and 0.76, respectively). Significant positive associations were observed between Frantic Hopelessness and BSI depression and anxiety subscales, between Ruminative Flooding and BSI anxiety and paranoia subscales, and Near Psychotic Somatization and BSI somatization subscales. Suicidal subjects with suicide attempt history had mean scores 7 points higher than those without history of suicide attempts. Frantic hopelessness was a significant predictor of current suicide attempt when only attempts requiring at least some medical attention were considered. CONCLUSION The STS-3 measures a distinct clinical entity, provisionally termed the 'suicide trigger state.' Scores on the STS-3 or select subscales appear to relate to degree of suicidality in terms of severity of ideation, history of attempt, and presence of substantive current attempts. Further study is required to confirm the factor structure and better understand the nature of these relations.
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Affiliation(s)
- Zimri S Yaseen
- Department of Psychiatry and Behavioral Sciences, Beth Israel Medical Center, New York, New York, United States of America.
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Yaseen ZS, Fisher K, Morales E, Galynker II. Love and suicide: the structure of the Affective Intensity Rating Scale (AIRS) and its relation to suicidal behavior. PLoS One 2012; 7:e44069. [PMID: 22952877 PMCID: PMC3430651 DOI: 10.1371/journal.pone.0044069] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Accepted: 07/30/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Suicide has been linked to intense negative affect. However, little is known about the range of affects experienced by suicidal persons, or the separate effects of affect valence and intensity. We examine a novel self-report scale, the 17-item Affective Intensity Rating Scale (AIRS), and its relation to suicidality in a high-risk sample. METHODOLOGY/PRINCIPAL FINDINGS Patients presenting with suicidality were recruited from the Emergency Department in a large urban hospital, and completed a battery of assessments there. Structure of the AIRS was assessed using Maximum Likelihood Factor Analysis with Oblimin rotation. Convergent and divergent validity were assessed by regressing AIRS subscales against Brief Symptom Inventory subscales. Relation to suicidality was assessed by regression of suicide attempt status against scale and subscale scores, and individual items and two-way item interactions, along with significant clinical and demographic factors. 176 subjects were included in analyses. Three reliable subscales were identified within the AIRS measure: positive feelings towards self, negative feelings towards self, and negative feelings towards other. Only individual AIRS items associated significantly with suicide attempt status; strong 'feelings of love' associated positively with actual suicide attempt, while 'feelings of calm' and 'positive feelings towards self' associated negatively. Interaction analyses suggest 'calm' moderates the association of 'love' with suicide attempt. CONCLUSIONS/SIGNIFICANCE Factor analysis of the AIRS is consistent with a circumplex model of affect. Affective dimensions did not predict suicidal behavior, but intense feelings of love, particularly in the absence of protective feelings of calm or positive self-view associated with current attempt.
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Affiliation(s)
- Zimri S Yaseen
- Department of Psychiatry and Behavioral Sciences, Beth Israel Medical Center, New York, New York, USA.
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Fountoulakis KN, Pantoula E, Siamouli M, Moutou K, Gonda X, Rihmer Z, Iacovides A, Akiskal H. Development of the Risk Assessment Suicidality Scale (RASS): a population-based study. J Affect Disord 2012; 138:449-57. [PMID: 22301115 DOI: 10.1016/j.jad.2011.12.045] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Revised: 12/11/2011] [Accepted: 12/29/2011] [Indexed: 11/25/2022]
Abstract
BACKGROUND Suicide and suicide attempts are significant and costly public health problems. In order to prevent suicidal and other self-injurious behaviors, research on the multiple factors involved in these behaviors with comprehensive and user-friendly instruments is necessary. The aim of the current study was to construct a self-report instrument with emphasis on items describing suicide-related behavior itself rather than strongly related clinical features on the basis of a general population study. METHODS Twelve items comprising a new scale were applied to 734 subjects from the general population (40.6% males and 59.4% females) aged 40.8±11.5 along with the STAI and the CES-D. RESULTS The scoring method was developed on the basis of frequency table of responses to the individual scale items. The factor analysis returned 3 factors explaining 59.19% of total variance (Intention, Life, and History). The Cronbach's alpha was 0.85 for the Intention, 0.69 for the Life and 0.52 for the History subscale. LIMITATION The findings need replication in clinical and epidemiologic studies. CONCLUSION The RASS is a reliable and valid instrument which might prove valuable in the assessment of suicidal risk in the general population as well as in mental patients.
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