Hostname: page-component-586b7cd67f-t7fkt Total loading time: 0 Render date: 2024-11-28T05:00:22.213Z Has data issue: false hasContentIssue false
  • English
  • Français

Method of assessment determines prevalence of suicidal ideation among patients with depression

Published online by Cambridge University Press:  15 April 2020

M. Vuorilehto ,
H.M. Valtonen ,
T. Melartin ,
P. Sokero ,
K. Suominen  and
E.T. Isometsä
M. Vuorilehto
Affiliation:
Department of Mental Health and Alcohol Research, National Institute for Health and Welfare, Helsinki, Finland Department of Psychiatry, Helsinki University Central Hospital P.O. Box 590, 00029, HUS
H.M. Valtonen
Affiliation:
Department of PsychiatryCity of Helsinki, Health Centre, Psychiatry, Helsinki, Finland
T. Melartin
Affiliation:
Department of Mental Health and Alcohol Research, National Institute for Health and Welfare, Helsinki, Finland Department of Psychiatry, Helsinki University Central Hospital P.O. Box 590, 00029, HUS
P. Sokero
Affiliation:
Department of Mental Health and Alcohol Research, National Institute for Health and Welfare, Helsinki, Finland
K. Suominen
Affiliation:
Department of PsychiatryCity of Helsinki, Health Centre, Psychiatry, Helsinki, Finland
E.T. Isometsä*
Affiliation:
Department of Mental Health and Alcohol Research, National Institute for Health and Welfare, Helsinki, Finland Department of Psychiatry, Helsinki University Central Hospital P.O. Box 590, 00029, HUS Department of Psychiatry, University of Helsinki, Institute of Clinical Medicine, P.O. Box 22, FIN-00014, Finland
*
*Corresponding author. Tel.: +358 9 471 63728; fax: +358 9 47163735. E-mail address:[email protected], [email protected] (E.T. Isometsä).
Get access

Abstract

Background

How different ways of assessing suicidal ideation influence its prevalence, correlates and predictive validity among patients with major depressive disorder (MDD) remains unclear.

Methods

Within the Vantaa Primary Care Depression Study (PC-VDS, 91 patients) and the Vantaa Depression Study (VDS, 153 psychiatric out-and 41 inpatients), suicidal ideation was assessed with the Scale for Suicidal Ideation (SSI), Hamilton Depression Scale (HAM-D) item 3 and Beck Depression Inventory (BDI) item 9, and by asking whether patients had seriously considered suicide during the episode. The positive and negative predictive values (PPV, NPV) for suicide attempts during a six-month follow-up were investigated.

Results

Depending on the setting, 56–88% of patients had suicidal ideation in some of the assessments, but only 8–44% in all of them. Agreement ranged from negligible to moderate (kappa 0.06–0.64), being lowest among primary care patients. The correlates of suicidal ideation overlapped. No assessment had optimal sensitivity, specificity, PPV and NPV. Nevertheless, PPVs ranged up to 43%.

Conclusions

Which MDD patient is classified as having suicidal ideation depends strongly on the method of assessment, with the greatest variation likely in primary care. Differences in assessments may cause inconsistency in risk factors. Predicting suicide attempts is difficult, but not futile.

Keywords

Major depressive disorderSuicidal ideationSuicide attemptsSuicidePrimary health carePsychiatric care
Type
Original article
Information
European Psychiatry , Volume 29 , Issue 6 , August 2014 , pp. 338 - 344
Copyright
Copyright © Elsevier Masson SAS 2014

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Beck, A.T., Brown, G.K., Steer, R.A., Dahlsgaard, K.K., Grisham, J.R.Suicide ideation at its worst point: a predictor of eventual suicide in psychiatric outpatients. Suicide Life Threat Behav 1999;29:1–9.Google ScholarPubMed
Beck, A.T., Kovacs, M., Weissman, A.Assessment of suicidal intention: the scale for suicide ideation. J Consult Clin Psychol 1979;47:343–352.CrossRefGoogle ScholarPubMed
Beck, A.T., Ward, C.H., Mendelson, M., Mock, J., Erbaugh, J.An inventory for measuring depression. Arch Gen Psychiatry 1961;4:561–571.CrossRefGoogle ScholarPubMed
Brown, G.K., Beck, A.T., Steer, R.A., Grisham, J.R.Risk factors for suicide in psychiatric outpatients: a 20-year prospective study. J Consult Clin Psychol 2000;68:371–377.CrossRefGoogle ScholarPubMed
Claassen, C.A., Trivedi, M.H., Rush, A.J., Husain, M.M., Zisook, S.et al.Clinical differences among depressed patients with and without a history of suicide attempts: Findings from the STAR*D trial. J Affect Disord 2007;97:77–84.CrossRefGoogle ScholarPubMed
Diekstra, R.F., Garnefski, N.On the nature, magnitude, and causality of suicidal behaviors: an international perspective. Suicide Life Threat Behav 1995;25:36–57.Google Scholar
Hamilton, M.A rating scale for depression. J Neurol Neurosurg Psychiatry 1960;23:56–62.CrossRefGoogle ScholarPubMed
Holma, K.M., Melartin, T.K., Haukka, J., Holma, I.A., Sokero, T.P.et al.Incidence and predictors of suicide attempts in DSM-IV major depressive disorder: A five-year prospective study. Am J Psychiatry 2010;167:801–808.CrossRefGoogle ScholarPubMed
Isometsa, E.T., Heikkinen, M.E., Marttunen, M.J., Henriksson, M.M., Aro, H.M.et al.The last appointment before suicide: is suicide intent communicated?. Am J Psychiatry 1995;152:919–922.Google ScholarPubMed
Isometsa, E.T., Henriksson, M.M., Aro, H.M., Heikkinen, M.E., Kuoppasalmi, K.I., Lönnqvist, J.K.Suicide in major depression. Am J Psychiatry 1994;150:530–536.Google Scholar
Isometsa, E.T., Lonnqvist JK:, Suicide attempts preceding completed suicide. Br J Psychiatry 1998;173:531–535.CrossRefGoogle ScholarPubMed
Joiner, T.E. Jr., Steer, R.A., Brown, G., Beck, A.T., Pettit, J.W.et al.Worst-point suicidal plans: a dimension of suicidality predictive of past suicide attempts and eventual death by suicide. Behav Res Ther 2003;41:1469–1480.CrossRefGoogle ScholarPubMed
Kraemer, H.C., Kupfer, D.J., Narrow, W.E., Clarke, D.E., Regier, D.A.Moving toward DSM-5: the field trials. Am J Psychiatry 2010;167:1158–1160.CrossRefGoogle ScholarPubMed
Mann, J.J., Ellis, S.P., Waternaux, C.M., Liu, X., Oquendo, M.A.et al.Classification trees distinguish suicide attempters in major psychiatric disorders: A model of clinical decision making. J Clin Psychiatry 2008;69:23–31.CrossRefGoogle Scholar
Mann, J.J., Waternaux, C., Haas, G.L., Malone, K.M.Toward a clinical model of suicidal behavior in psychiatric patients. Am J Psychiatry 1999;156:181–189.Google Scholar
Melartin, T.K., Rytsala, H.J., Leskela, U.S., Lestela-Mielonen, P.S., Sokero, T.P.et al.Current comorbidity of psychiatric disorders among DSM-IV major depressive disorder patients in psychiatric care in the Vantaa depression study. J Clin Psychiatry 2002;63:126–134.CrossRefGoogle ScholarPubMed
Meyer, R.E., Salzman, C., Youngstrom, E.A., Clayton, P.J., Goodwin, F.K.et al.Suicidality and risk of suicide-definition, drug safety concerns, and a necessary target for drug development: a consensus statement. J Clin Psychiatry 2010;71:e1–e21.CrossRefGoogle Scholar
Morris, D.W., Trivedi, M.H., Husain, M.M., Fava, M., Budhwar, N.et al.Indicators of pretreatment suicidal ideation in adults with major depressive disorder. Acta Psychiatr Scand 2010;121:480–484.CrossRefGoogle ScholarPubMed
Nordentoft, M., Mortensen, P.B., Pedersen CB:, Absolute risk of suicide after first hospital contact in mental disorder. Arch Gen Psychiatry 2011;68:1058–1064.CrossRefGoogle ScholarPubMed
Posner, K., Brown, G.K., Stanley, B., Brent, D.A., Yershova, K.V.et al.The columbia-suicide severity rating scale: Initial validity and internal consistency findings from three multisite studies with adolescents and adults. Am J Psychiatry 2011;168:1266–1277.CrossRefGoogle ScholarPubMed
Posner, K., Oquendo, M.A., Gould, M., Stanley, B., Davies, M.Columbia classification algorithm of suicide assessment (C-CASA): classification of suicidal events in the FDA's pediatric suicidal risk analysis of antidepressants. Am J Psychiatry 2007;164:1035–1043.CrossRefGoogle ScholarPubMed
Rucci, P., Frank, E., Scocco, P., Calugi, S., Miniati, M.et al.Treatment-emergent suicidal ideation during 4 months of acute management of unipolar major depression with SSRI pharmacotherapy or interpersonal psychotherapy in a randomized clinical trial. Depress Anxiety 2011;28:303–309.CrossRefGoogle ScholarPubMed
Sokero, P., Eerola, M., Rytsala, H., Melartin, T., Leskela, U.et al.Decline in suicidal ideation among patients with MDD is preceded by decline in depression and hopelessness. J Affect Disord 2006;95:95–102.CrossRefGoogle ScholarPubMed
Sokero, T.P., Melartin, T.K., Rytsala, H.J., Leskela, U.S., Lestela-Mielonen, P.S.et al.Suicidal ideation and attempts among psychiatric patients with major depressive disorder. J Clin Psychiatry 2003;64:1094–1100.CrossRefGoogle ScholarPubMed
Trivedi, M.H., Wisniewski, S.R., Morris, D.W., Fava, M., Gollan, J.K.et al.Concise health risk tracking scale: a brief self-report and clinician rating of suicidal risk. J Clin Psychiatry 2011;72:757–764.CrossRefGoogle ScholarPubMed
Valtonen, H., Suominen, K., Mantere, O., Leppämäki, S., Arvilommi, P., Isometsä, E.T.Suicidal ideation and attempts in bipolar I and II Disorders. J Clin Psychiatry 2005;66:1456–1462.CrossRefGoogle ScholarPubMed
Valtonen, H.M., Suominen, K., Sokero, P., Mantere, O., Arvilommi, P.et al.How suicidal bipolar patients are depends on how suicidal ideation is defined. J Affect Disord 2009;118:48–54.CrossRefGoogle ScholarPubMed
Vuorilehto, M., Melartin, T., Isometsa, E.Depressive disorders in primary care: Recurrent, chronic, and co-morbid. Psychol Med 2005;35:673–682.CrossRefGoogle ScholarPubMed
Vuorilehto, M.S., Melartin, T.K., Isometsa, E.T.Suicidal behaviour among primary-care patients with depressive disorders. Psychol Med 2006;36:203–210.CrossRefGoogle ScholarPubMed
Weiss, N.S.Clinical epidemiology. In: Rothman, K.J., Greenland, S., Lash, T.L., editor. Modern epidemiology. Lippincott, Philadelphia: Williams & Wilkins; 2008. p. 641–651.Google Scholar
Zisook, S., Lesser, I.M., Lebowitz, B., Rush, A.J., Kallenberg, G.et al.Effect of antidepressant medication treatment on suicidal ideation and behavior in a randomized trial: An exploratory report from the combining medications to enhance depression outcomes study. J Clin Psychiatry 2011;72:1322–1332.CrossRefGoogle Scholar
Zisook, S., Trivedi, M.H., Warden, D., Lebowitz, B., Thase, M.E.et al.Clinical correlates of the worsening or emergence of suicidal ideation during SSRI treatment of depression: An examination of citalopram in the STAR*D study. J Affect Disord 2009;117:63–73.CrossRefGoogle ScholarPubMed
Submit a response

Comments

No Comments have been published for this article.