First Step Validation Study for Four Subtypes of Suicidality in Mental Health

Abstract

Background Based on clinical experience, a differentiation model for suicidality consisting of four subtypes of suicidality was developed. 1) perceptual disintegration (PD), 2) primary depressive cognition (PDC), 3) psychosocial "turmoil" (PT) and 4) inadequate communication/coping (IC). A study was carried out to examine the validity of the proposed subtypes in absolute/discrete, gradual way and with a self -developed gradual questionnaire. Objective A first step was to examine the model and questionnaire for feasibility, reliability and validity in clinical practice. The “real life”, practical application of the model was examined, as were the resulting suggestions for improvement. Methods Discharge letters to general practitioners of 25 cases of anonymized suicidal emergency patients were independently reviewed and coded/classified by three psychiatrists, and three nurses. The SUICIDI-2 questionnaire was created to be able to describe our proposed subtypes of suicidal behaviour and was used in this study to allocate cases to these subtypes. Intraclass Correlation Coefficients (ICC) for absolute/discrete and gradual scores were calculated to examine the model’s validity. The study was approved by an ethical board.. Results All reviewers were able to assign subtypes, using the SUICIDI-2’s absolute and gradual scores, for all cases. We found an average measure of good reliability for absolute/discrete subtypes. For gradual scores, we found excellent average measures for the subtype PDC, and good for the subtypes PD, PT and IC. The reliability of gradual score for the SUICIDI-2 was relatively lower than an alternative gradual scoring, but had a good ICC value for all subtypes. The formulation for PD and IC was discussed with the reviewers and agreement was found about definitions. Conclusions The subtypes are validly delineated. After reviewing the results though, we found the interference of substance use was not consistently assessed by all raters. This was grounds to narrow down the criteria of the questionnaire and describe the model more clearly. The SUICIDI-2 questionnaire will be revised. A follow-up study with more conclusions for validation will looked at in relation to clinical and demographic aspects. It is essential for psychologists and other professionals to be involved in the further development and follow-up of the model and validation.