El perfil de disregulación del SDQ y su relación con conductas y pensamientos de suicidio en adolescentes evaluados en contexto clínico / The SDQ dysregulation profile is associated with self-injurious thoughts and behaviors in adolescents evaluated at a clinical setting

Introducción: La ideación suicida, la conducta suicida y las conductas autolesivas sin intención suicida (autolesiones) son un grave problema de salud pública en la adolescencia. Una proporción significativa de de adolescentes evaluados en contexto clínico muestran un perfil de disregulación (DP). El DP se caracteriza por inquietud, irritabilidad, «tormentas afectivas», inestabilidad emocional y agresiones que aparecen de forma desproporcionada ante determinadas situaciones, y parece estar relacionado con un mayor riesgo de pensamientos y conductas suicidas y autolesivas. Métodos: Doscientos treinta y nueve adolescentes del Centro de Salud Mental Infantojuvenil del Servicio de Psiquiatría de la Fundación Jiménez Díaz fueron evaluados con la Escala de Fortalezas y Dificultades para obtener el DP y con la entrevista estructurada sobre suicidio y autolesiones; se recogió también información sociodemográfica. Resultados: Estudios de regresión logística mostraron que los adolescentes con elevación del DP tenían más riesgo de presentar planes de suicidio, gestos suicidas e intentos suicidas. Igualmente, mostraron más riesgo de autolesiones. Conclusiones: Los resultados apuntan a dificultades de autorregulación tras la presencia de planes de suicidio, gestos suicidas, intentos de suicidio y autolesiones. De cara al futuro, estudios longitudinales permitirían esclarecer la dirección de dicha relación

Introduction: Suicidal ideation, suicidal behavior, and non-suicidal self-injury behavior are serious public health problems among adolescents. A significant proportion of adolescents evaluated in clinical settings meet criteria for the dysregulation profile (DP). DP is characterized by restlessness, irritability, "affective storms", mood instability, and aggression in a disproportionate grade to the situation. This DP might be related to increased risk of self-injurious thoughts and behaviors. Methods: Two hundred and thirty-nine adolescents from the Child and Adolescent Outpatient Psychiatric Services of the Jimenez Diaz Foundation, Madrid, were assessed with the Strengths and Difficulties Questionnaire-Dysregulation Profile, the Self-Injurious Thoughts and Behaviors Interview and socio-demographic questionnaires. Results: Logistic regression showed that DP adolescents were at increased risk for suicide plans, gestures, and suicide attempts. They also tended to present more self-injurious behaviors than adolescents without DP. Conclusions: Our results point to the role of self-regulatory problems in the presence of suicide plans, suicide gestures, suicide attempts, and in non-suicidal self-injury behavior. Longitudinal studies are needed to confirm the relationship between the Strengths and Difficulties Questionnaire-Dysregulation Profile and self-injurious thoughts and behaviors

Onset of schizophrenia diagnoses in a large clinical cohort.

We aimed to describe the diagnostic patterns preceding and following the onset of schizophrenia diagnoses in outpatient clinics. A large clinical sample of 26,163 patients with a diagnosis of schizophrenia in at least one outpatient visit was investigated. We applied a Continuous Time Hidden Markov Model to describe the probability of transition from other diagnoses to schizophrenia considering time proximity. Although the most frequent diagnoses before schizophrenia were anxiety and mood disorders, direct transitions to schizophrenia usually came from psychotic-spectrum disorders. The initial diagnosis of schizophrenia was not likely to change for two of every three patients if it was confirmed some months after its onset. When not confirmed, the most frequent alternative diagnoses were personality, affective or non-schizophrenia psychotic disorders. Misdiagnosis or comorbidity with affective, anxiety and personality disorders are frequent before and after the diagnosis of schizophrenia. Our findings give partial support to a dimensional view of schizophrenia and emphasize the need for longitudinal assessment.

The SDQ dysregulation profile is associated with self-injurious thoughts and behaviors in adolescents evaluated at a clinical setting. / El perfil de disregulación del SDQ y su relación con conductas y pensamientos de suicidio en adolescentes evaluados en contexto clínico.

INTRODUCTION: Suicidal ideation, suicidal behavior, and non-suicidal self-injury behavior are serious public health problems among adolescents. A significant proportion of adolescents evaluated in clinical settings meet criteria for the dysregulation profile (DP). DP is characterized by restlessness, irritability, "affective storms", mood instability, and aggression in a disproportionate grade to the situation. This DP might be related to increased risk of self-injurious thoughts and behaviors. METHODS: Two hundred and thirty-nine adolescents from the Child and Adolescent Outpatient Psychiatric Services of the Jimenez Diaz Foundation, Madrid, were assessed with the Strengths and Difficulties Questionnaire-Dysregulation Profile, the Self-Injurious Thoughts and Behaviors Interview and socio-demographic questionnaires. RESULTS: Logistic regression showed that DP adolescents were at increased risk for suicide plans, gestures, and suicide attempts. They also tended to present more self-injurious behaviors than adolescents without DP. CONCLUSIONS: Our results point to the role of self-regulatory problems in the presence of suicide plans, suicide gestures, suicide attempts, and in non-suicidal self-injury behavior. Longitudinal studies are needed to confirm the relationship between the Strengths and Difficulties Questionnaire-Dysregulation Profile and self-injurious thoughts and behaviors.

Screening for the ADHD Phenotype Using the Strengths and Difficulties Questionnaire in a Clinical Sample of Newly Referred Children and Adolescents.

OBJECTIVE: To examine the screening ability of the Strengths and Difficulties Questionnaire (SDQ) for ADHD subtypes in a clinical sample. METHOD: Parents of 523 children (3 to 17 years old) referred to Child and Adolescent Mental Health Services completed the Spanish version of the SDQ and the ADHD Rating Scale-IV. Receiver operating curve (ROC) curve analyses and likelihood ratios (LRs) were conducted. RESULTS: The LR results indicated that the 8/10 cutoff showed the highest diagnostic accuracy. The sensitivity of the SDQ 8/10 cutoff for the three subtypes was significantly different: 84.0% (95% confidence interval [CI] = [75.58, 89.90]) of ADHD combined subtype (ADHD-Co), 25.0% (95% CI = [17.55, 34.30]) of ADHD predominantly inattentive subtype (ADHD-I), and 77.8% (95% CI = [68.71, 84.83]) of ADHD predominantly hyperactive/impulsive subtype (ADHD-H). Sex and age differences were found. These screening differences were also found when using the 7/10 cutoff or the SDQ predictive algorithm. CONCLUSION: Our study supports the use of the SDQ in the screening for ADHD. However, not all ADHD subtypes are equally screened.

Coprophagia in a patient with borderline personality disorder

Background and Objectives: Human coprophagia is a rare phenomenon with severe medical and social consequences. So far, coprophagia has mainly been associated with severe mental retardation, schizophrenia, dementia, and depression. We report a caseof coprophagia in a 30-year-old woman with Borderline Personality Disorder (DSM-IV).This case report illustrates the severity of symptoms and maladaptive social consequences of severe personality disorders, comparable to those of patients with schizophrenia. Pharmacological interventions and, particularly intensive psychotherapy might be effective for patients diagnosed with borderline personality disorder displaying severe behavior disorders. The treatment of choice for coprophagia is aversive behavioral intervention (AU)

Prevalencia y funciones de los pensamientos y conductas autoagresivas en una muestra de adolescentes evaluados en consultas externas de salud mental / Prevalence and functions of self-injurious thoughts and behaviors in a sample of Spanish adolescents assessed in mental health outpatient departments

Introducción. Las conductas suicidas y autoagresivas de los adolescentes suponen un importante problema de salud pública. Sin embargo, se desconoce en nuestro medio la prevalencia y funciones de la ideación así como de las conductas suicidas y autoagresivas en la población adolescente atendida en salud mental. Métodos. Un total de 267 adolescentes de entre 11 y 18 años fueron reclutados de las consultas ambulatorias del Servicio de Psiquiatría de la Fundación Jiménez Díaz del 1 de noviembre de 2011 al 31 de octubre de 2012. Se administró a todos los pacientes la Escala de Pensamientos y Conductas Autolesivas que evalúa la presencia, frecuencia y características de la ideación suicida, la planificación suicida, los gestos de suicidio, los intentos de suicidio y las autolesiones sin intención suicida. Resultados. Un 20,6% de los adolescentes afirmaron haber tenido ideación suicida; un 2,2% planes suicidas; un 9,4% gestos suicidas; un 4,5% intentos de suicidio y un 21,7% autolesiones al menos una vez a lo largo de su vida. El 47,6% de los adolescentes refirieron haber tenido a lo largo de su vida al menos una de las conductas estudiadas y el 47,2% de ellos señalaron 2 ó más de estas conductas. Con relación a la función atribuida a las conductas examinadas, la mayor parte se realizaron con la intención de regular emociones, a excepción de los gestos suicidas (que mostró una función relacionada con el contexto social). Conclusiones. Dadas las elevadas cifras en población clínica de prevalencia y comorbilidad, unido al conocido riesgo de transición de unas conductas autoagresivas a otras, se recomienda la evaluación sistemática y rutinaria de dichas conductas en los adolescentes atendidos en salud mental (AU)

Introduction. Suicidal and self-injurious behaviors in adolescents are a major public health concern. However, the prevalence of self-injurious thoughts and behaviors in Spanish outpatient adolescents is unknown. Methods. A total of 267 adolescents between 11 and 18 year old were recruited from the Child and Adolescent Outpatient Psychiatric Services, Jiménez Díaz Foundation (Madrid, Spain) from November 1st 2011 to October 31st 2012. All participants were administered the Spanish version of the Self-Injurious Thoughts and Behaviors Inventory, which is a structured interview that assesses the presence, frequency, and characteristics of suicidal ideation, suicide plans, suicide gestures, suicide attempts, and non-suicidal self-injury. Results. One-fifth (20.6%) of adolescents reported having had suicidal ideation at least once during their lifetime. Similarly, 2.2% reported suicide plans, 9.4% reported suicide gesture, 4.5% attempted suicide, and 21.7% reported non-suicidal self-injury, at least once during their lifetime. Of the whole sample, 47.6% of adolescents reported at least one of the studied thoughts or behaviors in their lifetime. Among them, 47.2% reported 2 or more of these thoughts or behaviors. Regarding the reported function of each type of thoughts and behaviors examined, most were performed for emotional regulation purposes, except in the case of suicide gestures (performed for the purposes of social reinforcement). Conclusions. he high prevalence and high comorbidity of self-injurious thoughts and behaviors, together with the known risk of transition among them, underline the need of a systematic and routine assessment of these thoughts and behaviors in adolescents assessed in mental health departments (AU)

[Prevalence and functions of self-injurious thoughts and behaviors in a sample of Spanish adolescents assessed in mental health outpatient departments]. / Prevalencia y funciones de los pensamientos y conductas autoagresivas en una muestra de adolescentes evaluados en consultas externas de salud mental.

INTRODUCTION: Suicidal and self-injurious behaviors in adolescents are a major public health concern. However, the prevalence of self-injurious thoughts and behaviors in Spanish outpatient adolescents is unknown. METHODS: A total of 267 adolescents between 11 and 18 year old were recruited from the Child and Adolescent Outpatient Psychiatric Services, Jiménez Díaz Foundation (Madrid, Spain) from November 1st 2011 to October 31st 2012. All participants were administered the Spanish version of the Self-Injurious Thoughts and Behaviors Inventory, which is a structured interview that assesses the presence, frequency, and characteristics of suicidal ideation, suicide plans, suicide gestures, suicide attempts, and non-suicidal self-injury. RESULTS: One-fifth (20.6%) of adolescents reported having had suicidal ideation at least once during their lifetime. Similarly, 2.2% reported suicide plans, 9.4% reported suicide gesture, 4.5% attempted suicide, and 21.7% reported non-suicidal self-injury, at least once during their lifetime. Of the whole sample, 47.6% of adolescents reported at least one of the studied thoughts or behaviors in their lifetime. Among them, 47.2% reported 2 or more of these thoughts or behaviors. Regarding the reported function of each type of thoughts and behaviors examined, most were performed for emotional regulation purposes, except in the case of suicide gestures (performed for the purposes of social reinforcement). CONCLUSIONS: The high prevalence and high comorbidity of self-injurious thoughts and behaviors, together with the known risk of transition among them, underline the need of a systematic and routine assessment of these thoughts and behaviors in adolescents assessed in mental health departments.

Clinical Correlates of Non-Suicidal Self-Injury (NSSI) in an Outpatient Sample of Adolescents.

Non-suicidal self-injury (NSSI) in adolescents is a major public health concern. The first goal of our study was to describe the characteristics and functions of NSSI and NSSI thoughts in an adolescent outpatient sample. The second goal was to examine which clinical factors discriminate between these two groups of patients. A group of 267 subjects was recruited from the Adolescent Outpatient Psychiatric Services, Jiménez Díaz Foundation (Madrid, Spain) from November 2011 to October 2012. All participants were administered the Spanish version of the Self-Injurious Thoughts and Behaviors Interview (SITBI). A total of 21.7% of patients reported having engaged in NSSI at least once in their lifetime. The most strongly endorsed function for NSSI was automatic negative reinforcement. In comparison with patients in the NSSI Thoughts group and the control group, patients in the NSSI group scored higher in Internalization of Anger and in all the scales comprising the Children's Depression Inventory. Our findings on the prevalence and functions of NSSI are consistent with the literature. NSSI was mainly performed for emotion regulation purposes; specifically, NSSI seems to be used to cope with anger and depression. In addition, internalization of anger might play a significant role in the maintenance of this behavior.

Biological and environmental predictors of the dysregulation profile in children and adolescents: the story so far.

Most children and adolescents attending mental health services exhibit severe affective and behavioral dysregulation. The dysregulation profile (DP) seems to be an indicator of self-regulatory problems, overall psychopathology, symptom severity, and functional impairment. Although there are studies signaling its importance as a marker of severe psychopathology and long-term impairment, little is known about its predictors. We reviewed the existing literature and found biological and environmental factors associated with the DP. The DP seems to have high heritability rates, blunted hypothalamic-pituitary-adrenal axis responses at stress tasks, and attention problems regardless of emotional context. Some family factors (such as abnormal qualities of upbringing, lower effortful control, parental hostility, and parental substance use disorders) are also related to the DP. More research about specific predictors of the DP is clearly needed. Longitudinal studies would help identify them more clearly.

Victimization exposure and suicidal ideation among Spaniard adolescents evaluated at outpatient mental health services.

Suicidal ideation among adolescents has been associated with victimization in various studies; however, the nature of this association is not clear. Our aim was to examine the influence of victimization exposure on suicidal ideation in a clinical sample of adolescents. Eleven to 17-year-old subjects were recruited from Child and Adolescent Outpatient Psychiatric Services. They completed the Self-Injurious Thoughts and Behaviors Interview, the Stressful Life Events Scale, the State-Trait Anger Expression Inventory, the Children's Depression Inventory, the Strengths and Difficulties Questionnaire, and the Family APGAR. Demographic data, developmental features, medical and psychiatric history, family history, and treatment histories were also evaluated. A backward stepwise logistic regression analysis was conducted to examine the influence of victimization exposure on suicidal ideation controlling for potential confounding variables. Two hundred and thirty-nine adolescents (62.3% male; mean age 14.31 years, SD=1.9) took part in this investigation. Of these, 20.9% reported victimization exposure. Adolescents who experienced peer victimization and/or were victims of a crime were significantly more likely to report suicidal ideation (χ2=10.05, df=1, p=0.002). However, suicidal ideation was only predicted by emotional and behavioral problems (χ2=4.79, df=1, p=0.029), depressive sympthomatology (χ2=3.17, df=1, p=0.075), and number of total stressful life events (χ2=4.02, df=1, p=0.045). Behavioral and emotional problems, as well as the accumulation of stressful life events may have a direct relation to suicidal ideation among adolescents evaluated at Child and Adolescent Mental Health Outpatient Services. Future studies might consider a comprehensive assessment of victimization and the cumulative effects of exposure to multiple stressful life events. Longitudinal designs are warranted.

Clinical features associated with suicide attempts versus suicide gestures in an inpatient sample.

UNLABELLED: The objective of this study was to test whether suicide attempters and suicide gesturers can be clinically differentiated. A total of 150 subjects who had attempted suicide at least once, had made a suicide gesture, had suicidal ideation, and/or had engaged in non-suicidal self-injury were recruited from the inpatient service of the Jiménez Díaz Foundation (Madrid, Spain). A multinomial regression analysis was conducted. Histrionic and antisocial personality disorders were risk factors specific to suicide gestures. Narcissistic personality disorder was specifically associated with suicide attempts. Borderline personality disorder was associated with both suicide gestures and attempts. A high level of impulsiveness was a risk factor specific to suicide attempts. CONCLUSION: Suicide attempters and suicide gesturers are two distinct, although partially overlapping, populations.

Imagen corporal y autoestima en mujeres mastectomizadas / Body image and self-esteem in women subjected to radical mastectomy

Objetivo: Estudiar la imagen corporal que construyen las pacientes diagnosticadas de cáncer de mama tras someterse a intervención quirúrgica, mastectomía radical y cirugía conservadora, tanto en lo referente a aspectos corporales relacionados directamente con la lesión como a zonas corporales no relacionadas, e investigar cómo esa imagen afecta a la autoestima centrada en lo corporal. Método: Contamos con una muestra de 23 pacientes (12 mujeres mastectomizadas y 11 con cirugía conservadora) y 24 mujeres sanas que sirvieron como grupo control. El instrumento de evaluación utilizado es la Técnica de la Rejilla Corporal. Se analizaron las diferencias entre los grupos mediante ANOVA de un factor y las pruebas no paramétricas H de Kruskal Wallis y U de Mann-Whitney. Resultados y conclusiones: Los resultados del estudio han permitido identificar qué aspectos son los más dañados en la autoestima y autoimagen de las pacientes, estableciendo que no existen diferencias significativas en la imagen corporal global y la autoestima centrada en lo corporal entre mujeres mastectomizadas y mujeres sometidas a cirugía conservadora, aunque sí en la imagen que se tiene de las zonas corporales específicamente implicadas en la cirugía. Sí se han encontrado diferencias entre estos dos grupos y el grupo de mujeres sanas en imagen corporal global y autoestima. Los resultados obtenidos permitirán identificar los aspectos de la imagen corporal más afectados en las pacientes y por tanto orientar posibles intervenciones psicológicas futuras hacia la reconstrucción adaptativa y sana de los mismos

Aim: To study the body image built by patients with breast cancer after surgery, radical mastectomy and partial mastectomy, related to body parts directly involved in surgery and not directly related to it, and to investigate how this image affects bodily self-esteem. Method: Our sample comprised 23 patients (12 had been subjected to radical mastectomy and 11 to partial mastectomy) and 24 healthy women (they served as control group). Participants were assessed with the Body Grid technique. We analyzed the differences between groups using one way ANOVA and non-parametric tests (namely, H de Kruskal Wallis and U de Mann-Whitney). Results: Our findings allowed us to identify which were the most damaged aspects about self-esteem and body image in these patients, showing that there were no significant differences in body image and bodily self-esteem between patients subjected to radical and partial mastectomy. However, we found significant differences between body parts directly involved in surgery and those not directly related to it. Finally, we found significant differences between both groups of patients and the control group regarding body image and self-esteem.Conclusions: Our results show that the Body Grid Technique is helpful to identify the most affected aspects of body image in patients subjected to mastectomy and tailor psychological treatments aimed at improving body image in these patients

Prevalence and correlates of psychopathology in children and adolescents evaluated with the strengths and difficulties questionnaire dysregulation profile in a clinical setting.

BACKGROUND: The clinical presentation of children and adolescents referred to mental health services is frequently complicated by comorbid and severe affective and behavioral dysregulation. This dysregulation phenotype seems to be an indicator of overall psychopathology, symptom severity and functional impairment. Currently, this phenotype is assessed by the Child Behavior Checklist. However, the widely used Strengths and Difficulties Questionnaire (SDQ) has been recently validated to screen the Dysregulation Profile (SDQ-DP) in clinical settings. The objective of this study was to determine the prevalence and demographic, psychosocial and clinical correlates of the SDQ-DP phenotype in a Spanish clinical sample. SAMPLING AND METHODS: In a clinical sample of 623 consecutively referred children and adolescents (4-17 years old), we compared clinical and sociodemographic correlates between subjects who met the SDQ-DP criteria (DP) and those who did not (NO_DP). Sociodemographic data, parent-rated SDQ, Children's Global Assessment Scale, Clinical Global Impression, family Apgar scale and clinical diagnoses were collected by experienced child and adolescent psychiatrists. RESULTS: Overall in our sample, 175 subjects (28.1%) met the SDQ-DP criteria (DP group). Compared with the NO_DP group, the DP subjects had significantly higher scores on internalizing and externalizing psychopathology, problems with peers and overall problems as well as significantly lower scores on prosocial behavior. Clinical diagnoses assigned revealed that DP subjects showed significantly greater psychiatric comorbidity. DP subjects also showed significantly worse family functioning and increased symptom severity and significantly lower scores on psychosocial functioning. CONCLUSIONS: A high prevalence of children and adolescents with the dysregulated profile, assessed by the SDQ-DP, was found in our clinical setting. The SDQ-DP may serve as an index of overall psychological severity and functional impairment. In addition, it may indicate family dysfunction. Further research is needed to validate the clinical value of SDQ-DP by examining longitudinal stability, heritability, adult outcome, risk factors and diagnostic correlates.

Aggressiveness across development and suicidal behavior in depressed patients.

The objective of this study was to determine differences in the pathway of aggressiveness across development between depressive subjects and normal controls, and to examine males and females separately with regard to level of aggression and suicidal behavior among depressed subjects. Participants were classified into 5 groups: depressed suicide attempters (DSA; n = 339), depressed non-suicide attempters (DNSA; n = 92), psychiatric controls who had attempted suicide (PSA; n = 188), psychiatric controls who had not attempted suicide (PNSA; n = 222), and normal controls (NC; n = 532). The level of aggressiveness across development in the different groups was examined using a 5 (DSA vs. DNSA vs. PSA vs. PNSA vs. NC)×3 (Childhood, Adolescence, and Adulthood) MANCOVA. Adjusted and separate models for males and females were conducted. Depressed subjects differed in severity of aggressiveness. The level of aggressiveness in individuals in the NC group remained stable across development, while subjects in the DSA and DNSA groups showed significantly higher levels of aggressiveness. This finding was also observed in subjects of the PSA and PNSA groups. The level of aggressiveness in males with depression significantly increased over time. In women, increasing levels of aggressiveness across development were only observed in depressed suicide attempters. Limitations of this study included use of semi-structured interview for the assessment of risk factors. We found significant differences in severity and in the pathway of aggressiveness across development between depressive subjects and normal controls. In addition, sex differences regarding level of aggression and suicidal behavior among depressed subjects were found.

Psychiatrists' and psychologists' practice patterns: different profiles in a Spanish clinical sample.

Important differences in clinical practice exist between psychiatrists and psychologists. However, there is scarce information on the characteristics of patients receiving treatment from these two groups of professionals. We examined the diagnoses assigned to the patients who received treatment from psychiatrists and psychologists in outpatient settings of Madrid, Spain, from 1980 to 2008. The psychologists were more likely to see anxiety-related disorders, whereas the psychiatrists tended to see disorders with a more prominent biological underpinning, such as schizophrenia or bipolar disorder. The profile of the patients seen by the psychologists is different from that of the psychiatrists. Disorders whose development is more related to distress were usually treated by the psychologists, whereas disorders with a more prominent biological underpinning were usually treated by the psychiatrists. In addition, the dramatic increase in the diagnosis of adjustment disorder might be related to the increasing "psychologization" and "medicalization" of the difficulties of everyday life.

Translation and validation of the ‘‘Self-Injurious Thoughts and Behaviours Interview’’ in a Spanish population with suicidal behaviour

Introducción. La mayor parte de instrumentos de evaluación que se utilizan en nuestro país examinan un rango limitado de conductas suicidas. En cambio, la escala Self-Injurious Thoughts and Behaviors Interview (SITBI), desarrollada en EE. UU., valora un rango más amplio de dichas conductas: intento de suicidio, ideación suicida, gestos suicidas y conductas autolesivas. Dada la carencia señalada, nos parece necesario validar la escala de pensamientos y conductas autolesivas (EPCA), traducción de la escala SITBI, en la población española. Material y métodos. Con objeto de examinar las propiedades psicométricas de la EPCA en una muestra española, la escala se administró a 150 adultos hospitalizados en el Servicio de Psiquiatría de la Fundación Jiménez Díaz. Para evaluar la fiabilidad test-retest de la escala, el protocolo de evaluación se volvió a administrar a todos aquellos pacientes que volvieron a ingresar en nuestra unidad al menos 6 meses después de la primera evaluación (n = 50). Para valorar la validez de constructo de nuestra escala, se administraron algunas de las escalas de evaluación de suicidio más utilizadas en nuestro país. Resultados. El acuerdo entre examinadores osciló entre k = 0,90 y 1. La fiabilidad test-retest fue muy buena en el caso de la ideación suicida, los planes suicidas y los intentos de suicidio; no obstante, fue inferior en el caso de las autolesiones y los gestos suicidas. Nuestros resultados apoyan también la validez de constructo de nuestra escala. Conclusiones. Nuestros resultados apoyan la fiabilidad (tanto entre-examinadores como test-retest) y validez de constructo de la EPCA en población española(AU)

Introduction: Most of the assessment tools used in our country examine a limited range of suicidal behaviours. In contrast, the Self-Injurious Thoughts and Behaviours Interview (SITBI), developed in the US, assesses a wider range of these behaviours: suicidal ideation, suicide attempt, suicidal gestures, and self-harming behaviours. Given this lack, we think it is necessary to validate the Escala de pensamientos and conductas autolesivas (EPCA), Spanish translation of the SITBI, in the Spanish population. Material and methods: The EPCA interview was administered to 150 inpatients in the Psychiatry Unit-Fundación Jiménez Díaz in order to examine its psychometric properties in a Spanish sample. To assess its test-retest reliability, the EPCA was again administered to those patients who were readmitted to hospital at least 6 months after the first assessment (n = 50). To examine its construct validity, some of the most used assessment tools in this research field were also administered. Results: Inter-rater agreement ranged from k = .90 to k = 1. Test-retest reliability was good in the case of suicidal ideation, suicide plans and suicide attempts; however, it was lower in the case of self-harming behaviours and suicidal gestures. Our results also support the construct validity of the scale. Conclusions: Our findings back the reliability (both inter-rater and test-retest) and construct validity of the EPCA in the Spanish population(AU)

Personality disorders and health problems distinguish suicide attempters from completers in a direct comparison.

BACKGROUND: Whether suicide attempters and completers represent the same population evaluated at different points along a progression towards suicide death, overlapping populations, or completely different populations is a problem still unresolved. METHODS: 446 Adult suicide attempters and knowledgeable collateral informants for 190 adult suicide probands were interviewed. Sociodemographic and clinical data was collected for both groups using semi-structured interviews and structured assessments. Univariate analyses and logistic regression models were conducted to explore the similarities and differences between suicide attempters and completers. RESULTS: Univariate analyses yielded significant differences in sociodemographics, recent life events, impulsivity, suicide intent, and distribution of Axis I and II disorders. A logistic regression model aimed at distinguishing suicide completers from attempters properly classified 90% of subjects. The most significant variables that distinguished suicide from attempted suicide were the presence of narcissistic personality disorder (OR=21.4; 95% CI=6.8-67.7), health problems (OR=20.6; 95% CI=5.6-75.9), male sex (OR=9.6; 95% CI=4.42-20.9), and alcohol abuse (OR=5.5; 95% CI=2.3-14.2). LIMITATIONS: Our study shares the limitations of studies comparing suicide attempters and completers, namely that information from attempters can be obtained from the subject himself, whereas the assessment of completers depends on information from close family or friends. Furthermore, different semi-structured instruments assessed Axis I and Axis II disorders in suicide attempters and completers. Finally, we have no data on inter-rater reliability data. CONCLUSIONS: Suicide completers are more likely to be male and suffer from alcohol abuse, health problems (e.g. somatic illness), and narcissistic personality disorder. The findings emphasize the importance of implementing suicide prevention programs tailored to suicide attempters and completers.

Early childhood sexual abuse increases suicidal intent.

Childhood sexual abuse has been consistently associated with suicidal behavior. We studied suicide attempt features in depressed individuals sexually abused as children. On average, sexual abuse started before age 9. It frequently coexisted with physical abuse. Suicide attempters more often had personality disorders and had endured abuse for longer, but did not differ in terms of other clinical characteristics from non-attempters. Earlier onset of sexual abuse and its duration were associated with more suicide attempts. However, when personality disorders were included in the regression model, only these disorders predicted number of attempts. The severity of sexual abuse and the coexistence of physical abuse were correlated with age at first suicide attempt. However, only severity of sexual abuse was marginally associated with age at first suicide attempt in the regression model. Finally, the earlier the age of onset of sexual abuse, the higher the intent, even after controlling for age, sex and personality disorders. This suggests that the characteristics of childhood sexual abuse, especially age of onset, should be considered when studying the risk for suicidal behavior in abused populations.