The Rorschach Suicide Constellation: Assessing Various Degrees of Lethality

Fowler, J. Christopher; Piers, Craig; Hilsenroth, Mark J.; Holdwick, Daniel J.; Padawer, Justin R.

doi:10.1207/s15327752jpa7602_13

Cited by 48 publications

(14 citation statements)

References 39 publications

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“…Wood et al (2015) overturned their positive meta-analytic findings for the Suicide Constellation with a post hoc study-by-study narrative review and critique. They agreed with the positive findings of one study (Fowler, Piers, Hilsenroth, Holdwick, & Padawer, 2001) but argued against three others. First, Wood et al argued against a finding that utilized cerebrospinal fluid levels of 5-hydroxyindoleacetic acid (CSF 5-HIAA) in recent suicide attempters as a suicide severity risk indicator (Lundback et al, 2006) because "suicide risk" was not the "central validity question" for the Suicide Constellation (Wood et al, 2015, p. 239).…”

Section: Wood Et Al's Negative Conclusion Are Not Based On Their Mesupporting

confidence: 73%

Standards, accuracy, and questions of bias in Rorschach meta-analyses: Reply to Wood, Garb, Nezworski, Lilienfeld, and Duke (2015).

Mihura¹,

Meyer²,

Bombel³

et al. 2015

Psychological Bulletin

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Wood, Garb, Nezworski, Lilienfeld, and Duke (2015) found our systematic review and meta-analyses of 65 Rorschach variables to be accurate and unbiased, and hence removed their previous recommendation for a moratorium on the applied use of the Rorschach. However, Wood et al. (2015) hypothesized that publication bias would exist for 4 Rorschach variables. To test this hypothesis, they replicated our meta-analyses for these 4 variables and added unpublished dissertations to the pool of articles. In the process, they used procedures that contradicted their standards and recommendations for sound Rorschach research, which consistently led to significantly lower effect sizes. In reviewing their meta-analyses, we found numerous methodological errors, data errors, and omitted studies. In contrast to their strict requirements for interrater reliability in the Rorschach meta-analyses of other researchers, they did not report interrater reliability for any of their coding and classification decisions. In addition, many of their conclusions were based on a narrative review of individual studies and post hoc analyses rather than their meta-analytic findings. Finally, we challenge their sole use of dissertations to test publication bias because (a) they failed to reconcile their conclusion that publication bias was present with the analyses we conducted showing its absence, and (b) we found numerous problems with dissertation study quality. In short, one cannot rely on the findings or the conclusions reported in Wood et al.

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Section: Wood Et Al's Negative Conclusion Are Not Based On Their Mesupporting

confidence: 73%

Standards, accuracy, and questions of bias in Rorschach meta-analyses: Reply to Wood, Garb, Nezworski, Lilienfeld, and Duke (2015).

Mihura¹,

Meyer²,

Bombel³

et al. 2015

Psychological Bulletin

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“…Different from traditional ordinal regression models that assume monotone effects of predictor variables [29], the continuation-ratio model uses separate coefficients for different outcome classes, at the same time automatically selects highly predictive variables (and their time scales) for each class. As prior studies suggest that predictors of the two classes may be different [30], it is desirable to model the moderate-risk and the high-risk classes using separate coefficients. The variable selection capability comes from the lasso-like shrinkage [31] that forces variables with weak association with the outcomes to have zero coefficients.…”

Section: Methodsmentioning

confidence: 99%

Risk stratification using data from electronic medical records better predicts suicide risks than clinician assessments

et al. 2014

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BackgroundTo date, our ability to accurately identify patients at high risk from suicidal behaviour, and thus to target interventions, has been fairly limited. This study examined a large pool of factors that are potentially associated with suicide risk from the comprehensive electronic medical record (EMR) and to derive a predictive model for 1–6 month risk.Methods7,399 patients undergoing suicide risk assessment were followed up for 180 days. The dataset was divided into a derivation and validation cohorts of 4,911 and 2,488 respectively. Clinicians used an 18-point checklist of known risk factors to divide patients into low, medium, or high risk. Their predictive ability was compared with a risk stratification model derived from the EMR data. The model was based on the continuation-ratio ordinal regression method coupled with lasso (which stands for least absolute shrinkage and selection operator).ResultsIn the year prior to suicide assessment, 66.8% of patients attended the emergency department (ED) and 41.8% had at least one hospital admission. Administrative and demographic data, along with information on prior self-harm episodes, as well as mental and physical health diagnoses were predictive of high-risk suicidal behaviour. Clinicians using the 18-point checklist were relatively poor in predicting patients at high-risk in 3 months (AUC 0.58, 95% CIs: 0.50 – 0.66). The model derived EMR was superior (AUC 0.79, 95% CIs: 0.72 – 0.84). At specificity of 0.72 (95% CIs: 0.70-0.73) the EMR model had sensitivity of 0.70 (95% CIs: 0.56-0.83).ConclusionPredictive models applied to data from the EMR could improve risk stratification of patients presenting with potential suicidal behaviour. The predictive factors include known risks for suicide, but also other information relating to general health and health service utilisation.

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“…The index was found to be significant in samples of adult patients indicating high level of distress (Exner, 2003;Fowler, Piers, Hilsenroth, Holdwick, & Padawer, 2001). Although usually not applicable for children, Clinton and Jenkins-Monroe (1994), found significant S-CON in children who were sexually abused.…”

Section: S-conmentioning

confidence: 99%

Assessing Effects of National Trauma on Adaptive Functioning of Mentally Healthy Adults: An Exploratory Rorschach Study

Tibon

Rothschild²,

Appel³

et al. 2011

PSYCH

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The study evaluates deviations in Rorschach indices, usually related to effects of exposure to trauma, in three samples of Israeli adult non-patients. Data collected from 41 Israeli undergraduates in 1996-1997, during a period of increased rate of terror attacks in central cities of the country (Tibon, 2007) respectively. Nonetheless, the Lebanon War Exposure sample showed a tendency towards being alert and suspicious in interpersonal relationships. The data are interpreted as demonstrating the utility of the Rorschach as an assessment tool that is more responsive than previously thought to non-personality contextual factors such as national trauma.

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The Rorschach Suicide Constellation: Assessing Various Degrees of Lethality

Cited by 48 publications

References 39 publications

Standards, accuracy, and questions of bias in Rorschach meta-analyses: Reply to Wood, Garb, Nezworski, Lilienfeld, and Duke (2015).

Standards, accuracy, and questions of bias in Rorschach meta-analyses: Reply to Wood, Garb, Nezworski, Lilienfeld, and Duke (2015).

Risk stratification using data from electronic medical records better predicts suicide risks than clinician assessments

Assessing Effects of National Trauma on Adaptive Functioning of Mentally Healthy Adults: An Exploratory Rorschach Study

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