RISK ASSESSMENT OF A SUICIDE IN RELATION TO A PERSONALITY STRUCTURE IN PATIENTS WITH DEPRESSION
Abstract
Introduction: The issue of suicidal risk ,and suicide in general, represents one of the biggest challenges in psychiatric evaluation. This issue is covered by an extensive scientific work with the purpose of creating the most precise evaluation of suicide and suicide risk.
The Aim: The main goal of this research is to validate psychopatological constructs of a personality isolated by MMPI and HAMD in relation with measured suicidal rate among the subjects in question. Also, goal of this research is to explore possible connecitons beetween standard clinical and sociodemographic variables with rate of suicidality.
Materials and methods: The sample group consists of patients that are based on the stationary ward of a psychiatric clinic, diagnosed with F32 and F33. All the data was collected by interview, questionnaire and official medical documentation. The prediction variables are presented by the score on MMPI-202 and HAM-D, and standard clinical and sociodemographic variables. Criteria variables represent the score on SBQ-R, as a measure of suicidal tendencies, and a category variable which marks the presence of suicide attempts in the past. During the data analysis, the following methods were used: descriptive statistics, bivariate correlation, regression analysis, comparisment of arithmetic mean and canonical discriminant analysis. Results: The research showed a positive and significant correlation between suicidal tendencies and the scales of: depression, paranoia, schizophrenia, psychoastenia (p<0.01), anxiety, social isolation (p<0.05), and the hospitalization count (p<0.01). The only one reliable predictor of suicidalty is depression (p<0.05).
Conclusion: The research concludes that the psychopathological constructs, isolated by MMPI, are connected with suicidal tendencies. However, the conclusion is that further research is necessary in terms of determining the quality and way of the connections that are achieved between the test and the suicidality.
Keywords: Suicidal risk, depression, MMPI, HAM-D, personality factors
References
Jans T, Taneli Y, Warnke, A. Suicide and self-harming behaviour. In: Rey JM editor. IACAPAP e-Textbook of Child and Adolescent Mental Health. Geneva: International Association for Child and Adolescent Psychiatry and Allied Professions; 2012. p.47-71.
Stanojević A, Nenadović M, Milošević D, Popović I. Faktori rizika za suicidalno ponašanje kod afektivnih poremećaja. Praxis medica 2016; 45(1): 23-28.
Troister T. A prospective study of psychache and its relationship to suicidality. (dissertation). Queen’s University; 2009.
Gangwisch J. Suicide risk Assessment. CML – Psychiatry 2010; 21(4): 113–119.
Brown GK, Beck AT, Steer RA, Grisham JR. Risk factors for suicide in psychiatric outpatients: a 20-year prospective study. J Consult Clin Psychol. 2000; 68:371-7
Haney EM, O’Neil ME, Carson S, et al. Suicide Risk Factors and Risk Assessment Tools: A Systematic Review. Washington (DC): Department of Veterans Affairs; 2012
Arsenault-Lapierre GKC, Turecki G. Psychiatric diagnoses in 3275 suicides: a meta-analysis. BMC Psychiatry 2004; 4:37
Keith Hawton CC, Kate Saunders, Camilla Haw, et al. University of Oxford’s Centre for Suicide Research. Clinical Guide: Assessment of suicide risk in people with depression [online] [Accessed on January 13 2017]. Available from URL http://cebmh.warne.ox.ac.uk/csr/Clinical_guide_assessing_suicide_risk.pdf .
Cvjetković-Bošnjak M, Soldatović-Spajić B. Suicidalni rizik u depresivnih pacijenata. Med preg. 2003; 506(1-2): 76-79.
APA. Practice Guideline For The Assessment and Treatment of Patients With Suicidal Behaviors. Am J Psych 2003; 160: 1-60.
Oquendo MA, Bernanke JA. Suicide risk assessment: tools and challenges. World Psychiatry. 2017;16(1):28-9.
Stringer B, van Meijel B, Eikelenboom M, et al. Recurrent suicide attempts in patients with depressive and anxiety disorders: the role of borderline personality traits. J Affect Disord. 2013;151(1):23-30.
Miller FT, Chabrier LA. Suicide attempts correlate with delusional content in major depression. Psychopathology. 1988;21(1):34-7.
Fuller-Thomson E, Hollister B. Schizophrenia and Suicide Attempts: Findings from a Representative Community-Based Canadian Sample. Schizophr Res Treatment. 2016; 2016:3165243.
Oglesby ME, Capron DW, Raines AM, Schmidt NB. Anxiety sensitivity cognitive concerns predict suicide risk. Psychiatry Res. 2015;226(1):252-6.
Thibodeau MA, Welch PG, Sareen J, Asmundson GJ. Anxiety disorders are independently associated with suicide ideation and attempts: propensity score matching in two epidemiological samples. Depress Anxiety. 2013;30(10):947-54.
Buckner JD, Lemke AW, Jeffries ER, Shah SM. Social anxiety and suicidal ideation: Test of the utility of the interpersonal-psychological theory of suicide. J Anxiety Disord. 2017;45:60-3.
Koller G, Preuss UW, Bottlender M, Wenzel K, Soyka M. Impulsivity and aggression as predictors of suicide attempts in alcoholics. Eur Arch Psychiatry Clin Neurosci. 2002;252(4):155-60.
Michaelis BH, Goldberg JF, Davis GP, Singer TM, Garno JL, Wenze SJ. Dimensions of impulsivity and aggression associated with suicide attempts among bipolar patients: a preliminary study. Suicide Life Threat Behav. 2004;34(2):172-6.
Trout DL. The role of social isolation in suicide. Suicide Life Threat Behav. 1980;10(1):10-23.
Fernandez de la Cruz L, Rydell M, Runeson B, et al. Suicide in obsessive-compulsive disorder: a population-based study of 36 788 Swedish patients. Mol Psychiatry. 2016.
Osman A, Bagge CL, Gutierrez PM, Konick LC, Kopper BA, Barrios FX. The Suicidal Behaviors Questionnaire-Revised (SBQ-R): validation with clinical and nonclinical samples. Assessment. 2001;8(4):443-454.
Biro M. Dijagnostička procena ličnosti (MMPI-202). Novi Sad: Futura publikacije i Filozofski fakultet; 1995.
Groth-Marnat G. Handbook of Psychological Assessment. NJ: John Wiley and Sons; 2009.
Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry 1960; 23:56–62
Stage KB, Bech P, Kragh-Sorensen P, Nair NP, Katona C. Differences in symptomatology and diagnostic profile in younger and elderly depressed inpatients. Journal of Affective Disorders 2001; 64: 239–248.
Glassmire DM, Stolberg RA, Greene RL, Bongar B. The utility of MMPI-2 suicide items for assessing suicidal potential: development of a Suicidal Potential Scale. Assessment 2001;8(3):281-90.
Kopper BA, Osman A, Barrios FX. Assessment of suicidal ideation in young men and women: the incremental validity of the MMPI-2 content scales. Death Stud. 2001;25(7):593-607.
Pompili M, Rihmer Z, Akiskal HS, et al. Temperament and personality dimensions in suicidal and nonsuicidal psychiatric inpatients. Psychopathology. 2008;41(5):313-21.
Kene P. Utility of the Personality Assessment Inventory in Assessing Suicide Risk (dissertation). Toledo: The University of Toledo; 2007.