Reliability and validity of proxy reports of impulsivity and aggression: An evidence-based assessment approach to psychological autopsy methods.

INTRODUCTION: Psychological autopsy methods often include measures of impulsivity and aggression. The aim is to assess their reliability and validity in a Spanish sample. METHODS: Cross-sectional web-based survey was fulfilled by 184 proband and proxy pairs. Data was collected on sociodemographic characteristics, impulsivity through Barratt Impulsiveness Scale (BIS-11), aggression through Buss-Perry Aggression Questionnaire (BPAQ), and history of suicide ideation. Proxies filled out BIS-11, BPAQ and suicide ideation with the responses they would expect from the probands. Reliability was assessed using intraclass correlation coefficients (ICC) between proband and proxies. Logistic regression analysis was performed to assess the predictive validity of proxy reports in predicting probands' suicide ideation. RESULTS: Bivariate analysis showed differences in BPAQ (Median 68 vs. 62; p=0.001), but not in BIS-11 (p>.050). BIS-11 showed good concordance (ICC=0.754; CI 95% 0.671-0.816) and BPAQ acceptable (ICC=0.592; CI 95% 0.442-0.699). In the probands regression model BPAQ predicted suicide ideation (OR 1.038; CI 95% 1.016-1.061) but not BIS-11 (OR 0.991; CI 95% 0.958-1.025). In the proxy-report model BPAQ also predicted probands' suicide ideation (OR 1.036; CI 95% 1.014-1.058) but not BIS-11 (OR 0.973; CI 95% 0.942-1.004). CONCLUSION: Used as proxy-reported assessment tools, BIS-11 showed better reliability than the BPAQ. However, both showed validity in Spanish population and could be included in psychological autopsy protocols.

Second victim experience in Spanish psychiatrists coping with patient suicide: A call for postvention.

BACKGROUND: Losing a patient by suicide may lead to psychological distress and mid/long-term personal and professional consequences for psychiatrists, becoming second victims. MATERIAL AND METHODS: The validated Spanish version of the Second Victim Experience and Support Tool (SVEST-E) questionnaire and a 30-item questionnaire created ad-hoc was administered online to psychiatrists from all over Spain to evaluate how patient suicide affects mental health professionals. RESULTS: Two hundred ninety-nine psychiatrists participated in the survey, and 256 completed the SVEST-E questionnaire. The results of the SVEST-E questionnaire revealed a negative impact of suicide on emotional and physical domains, although this seemed not to lead to work absenteeism. Most respondents desired peer support from a respected colleague and considered institutional support, although desirable, lacking. Almost 70% of surveyed stated that an employee assistance program providing free counseling to employees outside of work would be desirable. The ad-hoc questionnaire showed that up to 88% of respondents considered some suicides unavoidable, and 76% considered the suicide unexpected. Almost 60% of respondents reported no changes in the approach of patients with suicidal ideation/behavior, after losing a patient. However, up to 76% reported performing more detailed clinical evaluations and notes in the medical record. Up to 13% of respondents considered leaving or changing their job or advancing retirement after losing a patient by suicide. CONCLUSIONS: After a patient's suicide, psychiatrists often suffer the feelings of second victim, impacting personal and professional areas. The study results indicate the need for postvention strategies to mitigate the negative impact of patient suicide.

Pandemics and Suicide Rates in Spain: From the Spanish Flu to COVID-19.

Objective: The aim of this study was to examine suicide rates in Spain during the COVID-19 pandemic and the influenza pandemic of 1918-1920.Methods: Data on deaths by cause for the periods 1910-1925 and 2016-2020 were obtained from the National Statistics Institute of Spain.Results: During the Spanish influenza pandemic, a peak of deaths in 1918 due to influenza, acute bronchitis, pneumonia, and other respiratory diseases coincided with an increase in suicides (from 5.9 in 1917 to 6.6 per 100,000 population in 1918). The pattern was repeated in the COVID-19 pandemic during 2020, with an increase in suicides from 7.8 in 2019 to 8.3 per 100,000 population in 2020. In both cases, the male:female suicide ratio was reduced in similar proportion, with a higher net increase in the number of suicides among males but a higher percentage increase among females.Conclusions: Albeit limited, there is evidence that the pandemics may have affected suicide rates. However, the effect was most likely due to precipitation of different diathesis-stressor factors in each setting, given the different historical contexts.

El llamado síndrome de alienación parental y sus derivaciones / The so-called parental alienation syndrome and its derivations

La denigración de un progenitor por el otro es uno de los efectos más dañinos para el menor en situaciones de ruptura familiar, si bien el llamado síndrome de alienación parental (Gardner) como supuesto trastorno mental infantil, no ha obtenido la aceptación en las clasificaciones psiquiátricas internacionales, ni la necesaria validez y soporte científico, por lo que profesionales de la salud mental, peritos y juristas deberían evitar su empleo. En su lugar, cabe valerse de los criterios diagnósticos contemplados por las clasificaciones psiquiátricas diagnósticas internacionales que describimos. Es esencial establecer el diagnóstico diferencial a partir del síntoma del rechazo hacia un progenitor, cuestión que entraña dificultad y que puede requerir el concurso de un equipo multidisciplinar para valorar adecuadamente todos los aspectos evaluables. Los profesionales han de obrar con conocimiento de los límites de su ciencia, aportando aquellos datos y conclusiones que sean legítimos y válidos según tal premisa. (AU)

The denigration of one parent by the other would be one of the most damaging effects for the child in situations of family breakdown, although the so-called parental alienation syndrome (Gardner) as a supposed childhood mental disorder, has not obtained acceptance in psychiatric classifications nor the necessary validity and scientific support, so its use by mental health professionals, experts and lawyers should be avoided. Instead, one can use the diagnostic criteria contemplated by the international diagnostic psychiatric classifications that we describe. It is essential to establish the differential diagnosis based on the symptom of rejection of a parent, an issue that involves difficulty and may require the assistance of a multidisciplinary team to adequately evaluate all the evaluable aspects. Professionals must act with knowledge of the limits of their science, providing those data and conclusions that are legitimate and valid according to this premise. (AU)

[Brief Suicide Questionnaire. Inter-rater reliability]. / Protocolo breve de evaluación del suicidio: fiabilidad interexaminadores.

INTRODUCTION: Inter-rater agreement is a crucial aspect in the planning and performance of a clinical trial in which the main assessment tool is the clinical interview. The main objectives of this study are to study the inter-rater agreement of a tool for the assessment of suicidal behavior (Brief Suicide Questionnaire) and to examine whether the inter-examiner agreement when multiple ratings are made on a single subject is an efficient method to assess the reliability of an instrument. METHOD: In the context of designing a multicenter clinical trial, 32 psychiatrists assessed a videotaped clinical interview of a patient with suicidal behavior. In order to identify those items in which a greater level of discordance existed and detect the examiners whose ratings differed significantly from the average ratings, we used the DOMENIC method (Detecion of Multiple Examiners Not in Consensus). RESULTS: Inter-rater agreement was between poor (<70%) to excelent (90-100%. Inter-rater agreement in Brugha's list of threatening experiences ranged from 75.5 and 100%; in the Global Assessment of Functioning (GAF) Scale was 82.58%; in the Beck's Suicidal Intent Scale, ranged from 67.5 and 97%; in the Beck's Scale for Suicide Ideation, ranged from 63.5 and 100%; and in the Lethality Rating Scale was 88.39%. On the whole, the level of agreement among raters, both in general scores and in particular items, was appropriate. CONCLUSION: The proposed design allows the assessment of the inter-rater agreement in an efficient way (only in one session). In addition, regarding the Brief Suicide Questionnaire, inter-raters agreement was appropriate.

Protocolo breve de evaluación del suicidio: fiabilidad interexaminadores / Brief Suicide Questionnaire. Inter-rater reliability

Introducción. El acuerdo entre-examinadores es un aspecto fundamental en la planificación de cualquier trabajo de investigación donde la principal herramienta diagnóstica es la entrevista clínica. El objetivo de este estudio es valorar el acuerdo entre-examinadores de un instrumento de evaluación de la conducta suicida (Protocolo breve de evaluación del suicidio) utilizando las valoraciones de múltiples observadores en una sola sesión. Método. Durante la fase piloto de un estudio clínico multicéntrico centrado en la monitorización de intentos de suicidio, 32 examinadores evaluaron el vídeo de la entrevista clínica a un paciente simulado con conducta suicida. Para identificar los ítems en los que existía una mayor discordancia y a los examinadores cuyo criterio se alejaba más del acuerdo general, se utilizó el método Detection Of Multiple Examiners Not In Consensus (DOMENIC). Resultado. El acuerdo interexaminadores osciló entre pobre (<70%) y excelente (90-100%). En la escala de acontecimientos vitales estresantes el nivel de acuerdo osciló entre 48,4 y 97%; en la escala problemas psicosociales del DSM-IV, entre 75,5 y 100%; en la escala de evaluación de la actividad global fue de 82,58%; en la escala de intencionalidad suicida, osciló entre 67,5 y 97%; en la escala de ideación suicida, entre 63,5 y 100% y en la escala de letalidad del intento de suicidio fue de 88,39%. En general, los examinadores mostraron un nivel de acuerdo adecuado tanto en las puntuaciones globales de cada escala como en cada ítem en particular. Conclusiones. El diseño propuesto permite evaluar el acuerdo entre-examinadores de una forma eficiente (en una única sesión). Además, con respecto al Protocolo breve de evaluación del suicidio, el acuerdo entre-examinadores fue apropiado(AU)

Introduction. Inter-rater agreement is a crucial aspect in the planning and performance of a clinical trial in which the main assessment tool is the clinical interview. The main objectives of this study are to study the inter-rater agreement of a tool for the assessment of suicidal behaviour (Brief Suicide Questionnaire) and to examine whether the inter-examiner agreement when multiple ratings are made on a single subject is an efficient method to assess the reliability of an instrument. Method. In the context of designing a multicenter clinical trial, 32 psychiatrists assessed a videotaped clinical interview of a patient with suicidal behaviour. In order to identify those items in which a greater level of discordance existed and detect the examiners whose ratings differed significantly from the average ratings, we used the DOMENIC method (Detecion of Multiple Examiners Not in Consensus). Results. Inter-rater agreement was between poor (<70%) to excellent (90-100%. Inter-rater agreement in Brugha's list of threatening experiences ranged from 75.5% to 100%; in the Global Assessment of Functioning (GAF) Scale was 82.58%; in Beck's Suicidal Intent Scale, ranged from 67.5% to 97%; in Beck's Scale for Suicide Ideation, ranged from 63.5% to 100%; and in the Lethality Rating Scale was 88.39%. On the whole, the level of agreement among raters, both in general scores and in particular items, was appropriate. Conclusion. The proposed design allows the assessment of the inter-rater agreement in an efficient way (only in one session). In addition, regarding the Brief Suicide Questionnaire, inter-raters agreement was appropriate(AU)