| 1. |
- Haglund, Axel, et al.
(author)
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Suicide Immediately After Discharge From Psychiatric Inpatient Care : A Cohort Study of Nearly 2.9 Million Discharges
- 2019
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In: Journal of Clinical Psychiatry. - : Physicians Postgraduate Press. - 0160-6689 .- 1555-2101. ; 80:2
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Journal article (peer-reviewed)abstract
- OBJECTIVE: The risk of suicide is elevated after discharge from a psychiatric hospital. This study aimed to investigate how recent suicidal behavior affects the risk of suicide in patients with different psychiatric diagnoses immediately after discharge.METHODS: Registers with national coverage were linked to create a study cohort including all individuals discharged from psychiatric hospitals in Sweden from 1973 through 2009. Hazard ratios for discharge diagnoses were calculated. The risk of suicide within 30 days after discharge in each diagnostic category when suicidal behavior had been registered within 30 days before admission was estimated.RESULTS: A total of 3,695 suicides occurred after 2,883,088 discharges. If recent suicidal behavior was registered, the risk of completed suicide increased prominently in all diagnostic categories, but particularly for schizophrenia (hazard ratio [HR] = 8.9; 95% CI, 6.4-12.4) and other nonorganic psychosis (HR = 6.8; 95% CI, 5.1-9.0). Patients suffering from depression had the highest overall risk of suicide postdischarge (HR = 3.0; 95% CI, 2.7-3.3). This finding applied especially to male patients with depression (HR = 4.5; 95% CI, 4.0-5.0) or with reaction to crisis (HR = 3.6; 95% CI 3.0-4.4).CONCLUSIONS: A distinct elevation of the risk of suicide was seen in all diagnostic groups if a recent self-harm event had occurred, particularly among patients with psychotic disorders. Overall, the immediate risk of suicide after discharge was high regardless of recent suicidal behavior. The findings in this study have relevance for clinical decisions about immediate after-care and treatment in connection with discharge from psychiatric inpatient care.
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| 2. |
- Lindh, ÅU, et al.
(author)
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A Comparison of Suicide Risk Scales in Predicting Repeat Suicide Attempt and Suicide: A Clinical Cohort Study
- 2019
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In: The Journal of clinical psychiatry. - : Physicians Postgraduate Press. - 1555-2101 .- 0160-6689. ; 80:6
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Journal article (peer-reviewed)abstract
- OBJECTIVE: To compare the predictive accuracy of the Suicide Intent Scale (SIS), the Suicide Assessment Scale (SUAS), the Karolinska Interpersonal Violence Scale (KIVS), and the Columbia-Suicide Severity Rating Scale (C-SSRS) for suicide attempts and suicides within 3 and 12 months of an episode of self-harm. METHODS: This prospective multicenter cohort study included patients (N = 804) aged 18-95 years with a recent episode of self-harm assessed in psychiatric emergency settings from April 2012 to April 2016. Suicide attempts and suicides were identified in medical records and in the National Cause of Death Register. Receiver operating characteristic curves were constructed, and accuracy statistics were calculated. A sensitivity of at least 80% combined with a specificity of at least 50% were considered minimally acceptable. RESULTS: At least 1 suicide attempt was recorded for 216 participants during follow-up, and 19 participants died by suicide. The SUAS and C-SSRS were better than chance in classifying the 114 suicide attempts occurring within the first 3 months; a C-SSRS score ≥ 27 yielded a sensitivity/specificity of 79.8%/51.5% (P < .001). During 1-year follow-up, the SUAS and C-SSRS also performed better than chance, but no cutoff on either instrument gave a sensitivity/specificity of ≥ 80%/≥ 50%. The SIS was the only instrument that could classify suicides correctly. At 3 months, the area under the curve (AUC) was 0.94 (95% CI, 0.89-0.99), and a score ≥ 21 predicted suicide with a sensitivity/specificity of 100%/81.9%, based on only 4 suicides. At 1-year follow-up, the AUC was 0.74 (95% CI, 0.61-0.87), and a score ≥ 17 predicted suicide with a sensitivity/specificity of 72.2%/57.9%. CONCLUSIONS: Instruments that predicted nonfatal repeat suicide attempts did not predict suicide and vice versa. With the possible exception of the prediction of suicide by the SIS in a short time frame, the specificity of these instruments was low, giving them a limited relevance in the prediction of suicidal behaviors. © Copyright 2019 Physicians Postgraduate Press, Inc.
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| 3. |
- Wikberg, Carl, et al.
(author)
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Comparison Between the Montgomery-Asberg Depression Rating Scale–Self and the Beck Depression Inventory II in Primary Care
- 2015
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In: The Primary Care Companion for CNS Disorders. - 0160-6689 .- 1555-2101 .- 2155-7772. ; 17:3
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Journal article (peer-reviewed)abstract
- Objective: The Montgomery-Asberg Depression Rating Scale–Self (MADRS-S) and the Beck Depression Inventory II (BDI-II) are commonly used self-assessment instruments for screening and diagnosis of depression. The BDI-II has 21 items and the MADRS-S has 9 items. These instruments have been tested with psychiatric inpatients but not in outpatient primary care, where most patients with symptoms of depression initially seek treatment. The purpose of this study was to compare these 2 instruments in the primary care setting. Method: Data were collected from 2 primary care randomized controlled trials that were performed from 2010 to 2013 in Sweden: the Primary Care Self-Assessment MADRS-S Study and Primary Care Internet-Based Cognitive Behavioral Therapy Study. There were 146 patients (73 patients each from both trials) who had newly diagnosed mild or moderate depression (per DSM-IV recommendations) and who had assessment with both the MADRS-S and BDI-II at primary care centers. Comparability and reliability of the instruments were estimated by Pearson product moment correlation and Cronbach α. Results: A good correlation was observed between the 2 instruments: 0.66 and 0.62 in the 2 study cohorts. The reliability within the 2 study cohorts was good for both MADRS-S (Cronbach α: 0.76 for both cohorts) and BDI-II items (Cronbach α: 0.88 and 0.85). Conclusions: The 2 instruments showed good comparability and reliability for low, middle, and high total depression scores. The MADRS-S may be used as a rapid, easily administered, and inexpensive tool in primary care and has results comparable to the BDI-II in all domains.
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