[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.

Factors contributing to the utilization of adult mental health services in children and adolescents diagnosed with hyperkinetic disorder.

OBJECTIVES: To examine whether age of First diagnosis, gender, psychiatric comorbidity, and treatment modalities (pharmacotherapy or psychotherapy) at Child and Adolescent Mental Health Services (CAMHS) moderate the risk of Adult Mental Health Services (AMHS) utilization in patients diagnosed with hyperkinetic disorder at CAMHS. METHODS: Data were derived from the Madrid Psychiatric Cumulative Register Study. The target population comprised 32,183 patients who had 3 or more visits at CAMHS. Kaplan-Meier curves were used to assess survival data. A series of logistic regression analyses were performed to study the role of age of diagnosis, gender, psychiatric comorbidity, and treatment modalities. RESULTS: 7.1% of patients presented with hyperkinetic disorder at CAMHS. Compared to preschool children, children and adolescents first diagnosed with hyperkinetic disorder at CAMHS were more likely to use AMHS. Female gender and comorbidity with affective disorders, schizophrenia, schizotypal and delusional disorders increased the risk of use of AMHS. Pharmacological or combined treatment of hyperkinetic disorder diagnosed at CAMHS was associated with increased risk of use at AMHS. CONCLUSIONS: Older age of first diagnosis, female gender, psychiatric comorbidity, and pharmacological treatment at CAMHS are markers of risk for the transition from CAMHS to AMHS in patients with hyperkinetic disorder diagnosed at CAMHS.

Age of first suicide attempt in men and women: an admixture analysis.

OBJECTIVES: To define different subgroups of suicide attempters according to age at onset of suicide attempts. METHODS: Participants were 229 suicide attempters (147 females; 82 males) admitted to a general hospital in Madrid, Spain. We used admixture analysis to determine the best-fitting model for the age at onset of suicide attempts separated by sex. RESULTS: The best fitted model for the age at onset of suicide attempts was a mixture of two gaussian distributions. Females showed an earlier age at onset of suicide attempts in both Gaussian distributions (mean ± S.D.) (26.98 ± 5.69 and 47.98 ± 14.13) than males (32.77 ± 8.11 and 61.31 ± 14.61). Early-onset female attempters were more likely to show borderline personality disorder than late-onset female attempters (OR = 11.11; 95% CI = 2.43-50.0). CONCLUSIONS: Age at onset of suicide attempts characterizes different subpopulations of suicide attempters.

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)

Can the Holmes-Rahe Social Readjustment Rating Scale (SRRS) be used as a suicide risk scale? An exploratory study.

The objective of this research was to examine whether the Holmes-Rahe Social Readjustment Rating Scale, a life event scale, can be used to identify suicide attempters. The Holmes-Rahe Social Readjustment Rating Scale's ability to identify suicide attempters was tested in 1183 subjects (478 suicide attempters, 197 psychiatric inpatients, and 508 healthy controls) using the Fisher Linear Discriminant Analysis and traditional psychometric methods. The Fisher Linear Discriminant Analysis outperformed traditional psychometric approaches (area under the curve: 0.85 vs. 0.78; p < 0.05) and indicated that this scale may be used to identify suicide attempters. The life events that better characterized suicide attempters were change in frequency of arguments, marital separation, and personal injury. The Holmes-Rahe Social Readjustment Rating Scale may help identify suicide attempters.

Improving the accuracy of suicide attempter classification.

OBJECTIVE: Psychometrical questionnaires such as the Barrat's impulsiveness scale version 11 (BIS-11) have been used in the assessment of suicidal behavior. Traditionally, BIS-11 items have been considered as equally valuable but this might not be true. The main objective of this article is to test the discriminative ability of the BIS-11 and the international personality disorder evaluation screening questionnaire (IPDE-SQ) to predict suicide attempter (SA) status using different classification techniques. In addition, we examine the discriminative capacity of individual items from both scales. MATERIALS AND METHODS: Two experiments aimed at evaluating the accuracy of different classification techniques were conducted. The answers of 879 individuals (345 SA, 384 healthy blood donors, and 150 psychiatric inpatients) to the BIS-11 and IPDE-SQ were used to compare the classification performance of two techniques that have successfully been applied in pattern recognition issues, Boosting and support vector machines (SVM) with respect to linear discriminant analysis, Fisher linear discriminant analysis, and the traditional psychometrical approach. RESULTS: The most discriminative BIS-11 and IPDE-SQ items are "I am self controlled" (Item 6) and "I often feel empty inside" (item 40), respectively. The SVM classification accuracy was 76.71% for the BIS-11 and 80.26% for the IPDE-SQ. CONCLUSIONS: The IPDE-SQ items have better discriminative abilities than the BIS-11 items for classifying SA. Moreover, IPDE-SQ is able to obtain better SA and non-SA classification results than the BIS-11. In addition, SVM outperformed the other classification techniques in both questionnaires.

Short self-reported sleep duration and suicidal behavior: a cross-sectional study.

BACKGROUND: Prior studies on the association between sleep disturbances and suicidal behavior did not explore whether or not short sleep is a marker of suicide intent, lethality or risk. DESIGN: Cross-sectional. PARTICIPANTS: Suicide attempters (SAs) (n=434). Controls included 83 psychiatric inpatients who have never been SAs, and 509 healthy controls. MEASUREMENTS: Short sleep was defined by self-assessment as ≤ 5 h per day. The MINI and the DSM-IV version of the International Personality Disorder Examination Screening Questionnaire were used to diagnose Axis I and Axis II diagnoses, respectively. Suicide intent and lethality were evaluated through the Beck's Suicidal Intent Scale (SIS) and the Risk-Rescue Rating Scale (RRRS), respectively. Beck's Medical Lethality Scale (BMLS) was administered to assess the degree of medical injury, and the SAD PERSONS mnemonic scale was used to evaluate suicide risk. STATISTICAL ANALYSES: Chi-square tests and logistic regression analyses explored frequencies of short sleep in 3 samples. Chi-square tests explored whether or not suicide intent, lethality and risk were greater in SAs with short-sleep versus those without short-sleep. RESULTS: Short sleep was more prevalent in SAs than in psychiatric controls only in males. In female SAs, short sleep was significantly associated with several SIS items and high scores in the SAD PERSONS. LIMITATIONS: Sleep duration was assessed only by self-report. CONCLUSIONS: The association between short sleep and suicidal behavior may be partly explained by confounders. Short sleep may be a marker of severity of suicidal behavior among female SAs.