Dissociative Disorders and Suicidality in Psychiatric Outpatients

Foote, Brad; Smolin, Yvette; Neft, Deborah; Lipschitz, Deborah S.

doi:10.1097/nmd.0b013e31815fa4e7

Cited by 175 publications

(116 citation statements)

References 39 publications

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“…Some clinicians experienced in the treatment of DDs have noted that many of their patients, particularly with DID and DDNOS-I, have both considerable comorbidity and low levels of functioning (Kluft, 1999;Van der Hart et al, 2006). This is in line with previous studies that found a high comorbidity and an extensive psychiatric treatment history in DID subjects (Putnam et al, 1986;Ross et al, 1989;Boon & Draijer, 1993;Ellason et al, 1996;Dell, 1998), as well as a strong association with self-harming behavior and suicidality (Foote et al, 2008). However, there is a need for systematic research on the functional impact of DDs.…”

Section: Introductionsupporting

confidence: 90%

Global functioning and disability in dissociative disorders

Mueller‐Pfeiffer

Rufibach

Perron

et al. 2012

Psychiatry Research

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Section: Introductionsupporting

confidence: 90%

Global functioning and disability in dissociative disorders

Mueller‐Pfeiffer

Rufibach

Perron

et al. 2012

Psychiatry Research

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“…Furthermore, we expected that patients in the earlier stages of treatment, who struggle with safety issues such as self-injurious behaviour and suicidality (e.g. Coons & Milstein, 1990; Foote, Smolin, Neft, & Lipschitz, 2008), would incur greater treatment costs compared to patients in the later stages of treatment.…”

Section: Highlightsmentioning

confidence: 99%

Treatment of dissociative disorders and reported changes in inpatient and outpatient cost estimates

Myrick

Webermann

Langeland

et al. 2017

European Journal of Psychotraumatology

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Background: Interpersonal trauma and trauma-related disorders cost society billions of dollars each year. Because of chronic and severe trauma histories, dissociative disorder (DD) patients spend many years in the mental health system, yet there is limited knowledge about the economic burden associated with DDs. Objective: The current study sought to determine how receiving specialized treatment would relate to estimated costs of inpatient and outpatient mental health services. Method: Patients’ and individual therapists’ reports of inpatient hospitalization days and outpatient treatment sessions were converted into US dollars. DD patients and their clinicians reported on use of inpatient and outpatient services four times over 30 months as part of a larger, naturalistic, international DD treatment study. The baseline sample included 292 clinicians and 280 patients; at the 30-month follow-up, 135 clinicians and 111 patients. Missing data were replaced in analyses to maintain adequate statistical power. The substantial attrition rate (>50%) should be considered in interpreting findings. Results: Longitudinal and cross-sectional analyses of cost estimates based on patient reported inpatient hospitalization significantly decreased over time. Longitudinal cost estimates based on clinician-reported outpatient services also significantly decreased over time. Cross-sectional cost estimates based on patient and clinician reported inpatient hospitalization were significantly lower for patients in later stages of treatment compared to those struggling with safety and stabilization. Cross-sectional cost estimates based on clinician-reported outpatient services were significantly lower for patients in later stages of treatment compared to those in early stages. Conclusions: This pattern of longitudinal and cross-sectional reductions in inpatient and outpatient costs, as reported by both patients and therapists, suggests that DD treatment may be associated with reduced inpatient and outpatient costs over time. Although these preliminary results show decreased mental health care utilization and associated estimated costs, it is not clear whether it was treatment that caused these important changes.

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“…Presence of a dissociative disorder is strongly associated with all measures of self-harm and suicidality (45). Self-destructive behavior is very common in the cases of DID.…”

Section: Discussionmentioning

confidence: 99%

Yatarak Tedavi Gören Bipolar Bozukluk Hastalarında Dissosiyatif Bozukluk Eştanısı Olan ve Olmayan Hasta Gruplarının Karşılaştırılması

Bakım

Baran

Güleken³

et al. 2016

Aile Hekimliği Ve Palyatif Bakım

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Introduction: This study aims to compare sociodemographic characteristics of the patients with bipolar disorder (BD) with and without comorbid dissociative disorder (DD) and to investigate the eventual effect of the comorbidity on the treatment. Methods:We enrolled a total of 149 patients diagnosed with BD and treated as inpatients consecutively in Şişli Etfal Hospital, Psychiatry Clinic between 2010 and 2011. For the patients who were diagnosed with DD using SCID-D and with BD using SCID-I, sociodemographic characteristics, YMRS, HAM-D, BPRS, DES scores and duration and number of hospital stays were evaluated. Results: 23 patients (15.4%) had dissociative disorder not otherwise specified (DD-NOS), 4 patients (2.6%) had dissociative identity disorder (DID) and 1 patient (0.6%) had dissociative amnesia. BD patients with comorbid DD were found to be predominantly female (p=0.015) and younger (p=0.002) and to have significantly higher DES scores than BD patients without DD (p<0.001). The total score of DES was correlated with duration hospital stay (p=0.001, Spearman r=0.336) in the total sample. Total HAM-D score at the time of admission was significantly higher in the comorbidity group (p=0.027), and suicide item was found to be significantly higher both at admission and at discharge (p<0.001 and p=0.035). Among BPRS scores at admission, hallucinatory behavior item was found to be higher in the comorbidity group (p=0.019). Among YMRS scores both at admission and at discharge, velocity and amount of speech item (p=0.027) and insight item at admission (p=0.006) was found to be significantly higher in the pure bipolar group (p=0.018). Conclusion:In patients with BD, DD comorbidity should be investigated. The BD patients with DD comorbidity tend to be female and younger, and show higher depression scores, leading to a prolonged hospital stay. In the presence of dissociation comorbidity, attempts and number of suicides and hallucinatory behaviors seem to be increased.

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Dissociative Disorders and Suicidality in Psychiatric Outpatients

Cited by 175 publications

References 39 publications

Global functioning and disability in dissociative disorders

Global functioning and disability in dissociative disorders

Treatment of dissociative disorders and reported changes in inpatient and outpatient cost estimates

Yatarak Tedavi Gören Bipolar Bozukluk Hastalarında Dissosiyatif Bozukluk Eştanısı Olan ve Olmayan Hasta Gruplarının Karşılaştırılması

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