Abstract
 

Validation for a Practical New Model to Differentiate Suicidality which can be used Across Various Clinical Settings

Remco F.P. de Winter MD PhD1,2,3

1. Medical directorate, Mental health institute Rivierduinen Leiden The Netherlands ,

2. Faculty neuropsychology and neuropsychology, Maastricht University. The Netherlands

3. Faculty psychology, Free University (VU), Amsterdam, The Netherlands

 

Introduction:
A clinical differentiation model for suicidality is expected to improve adherence to guidelines regarding management of suicidal patients and determine the most appropriate treatment for the different subtypes of suicidal behaviour. Practical clinical experience was used as a base to develop this model to differentiate subtypes of suicidality [1]. From clinical experience, a model was developed to differentiate subtypes of suicidality. The subtypes are 1) perceptual disintegration (PD), 2) primary depressive cognition (PDC), 3) psychosocial turmoil (PT) and 4) inadequate coping/communication (IC) [2, 3] . A SUICIDI-instrument (questionnaire version 2.0) was designed to identify subtypes.

Aim:
to examine the reliability and validity and consider any adjustments or improvements if needed.

Methods:
The  study was carried out in two parts (3): first a pilot of 25 cases followed by a validation study of 75 cases of anonymized suicidal emergency patients [2, 4]. Clinical and demographic features of patients were pseudonymized and saved. Cases were independently reviewed and rated with the SUICIDI-questionnaire by three psychiatrists, three nurse-specialists. Validity was examined by intraclass correlation coefficient (ICC) scores for absolute and dimensional validity. The study was approved by the ethical board.

Results:
In the pilot, an overall average ICC value of good reliability for the model was found. For dimensional scoring the type agreement was excellent for PDC, and  good for PD, PT and IC. After the pilot, the description of PD and IC was discussed with the raters and was adjusted. In the main study, all subtypes had an average ICC value of excellent reliability. The revised SUICIDI-instrument gave an excellent value for all subtypes. Specific clinical and demographic characteristics were found for the subtypes.  

Conclusion:
Subtypes of suicidal behaviours are validly delineated by ICC reliability research. The adjusted SUICIDI (version 3.2) questionnaire turned out to be a useful instrument to identify subtypes (de Winter et al revised). Substance use interaction was not consistently assessed by all raters. Specific clinical and demographic characteristics are identified and will be discussed.

Literature
1. de Groot MH, de Winter RF: De beoordeling van het suïciderisico. In: Handboek suïcidaal gedrag. edn. Edited by van Heeringen C PG, de Beurs D,  Kerkhof A. Utrecht: de Tijdstroom 2019.
2. de Winter RFP, Meijer CM, Enterman JH, Kool-Goudzwaard N, Gemen M, van den Bos AT, Steentjes D, van Son GE, Hazewinkel MC, de Beurs DP et al: A Clinical Model for the Differentiation of Suicidality: Protocol for a Usability Study of the Proposed Model. JMIR Res Protoc 2023, 12:e45438.
3. de Winter RFP, Meijer C, Kool N, de Groot MH: Differentiation of Suicidal Behavior in Clinical Practice. In: Suicide Risk Assessment and Prevention. edn. Edited by Pompili M. Cham: Springer International Publishing; 2022: 219-236.
4. de Winter RFP, Hazewinkel MC, van de Sande R, de Beurs DP, de Groot MH: Outreach Psychiatric Emergency Service. Crisis 2020, 41(5):375-382.

https://www.suicidaliteit.nl/2023/SUICIDI/Scoringslijst