Combining the Suicide Intent Scale and the Karolinska Interpersonal Violence Scale in suicide risk assessments

BMC Psychiatry

J. Jokinen²  M. Åsberg³  B. Runeson¹  P. Nordström¹  J. Stefansson¹ 

[1] Department of Clinical Neuroscience, Psychiatry Section, Karolinska Institutet, Karolinska University Hospital, Building R5, Solna SE-171 76, Stockholm, Sweden;Department of Clinical Sciences, Umeå University, Umeå, Sweden;Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden

关键词: Violence;    Psychometrics;    Aggression;    Risk factors;    Suicide attempt;    Suicide;   

Others  :  1229569
DOI  :  10.1186/s12888-015-0607-6

 received in 2015-02-17, accepted in 2015-09-10,  发布年份 2015

【 摘 要 】

Background

High suicide intent, childhood trauma, and violent behavior are risk factors for suicide in suicide attempters. The aim of this study was to investigate whether the combined assessment of suicide intent and interpersonal violence would provide a better prediction of suicide risk than an assessment of only suicide intent or interpersonal violence.

Methods

This is a cohort study involving 81 suicide attempters included in the study between 1993 and 1998. Patients were assessed with both the Suicide Intent Scale (SIS) and the Karolinska Interpersonal Violence Scale (KIVS). Through the unique personal identification number in Sweden, patients were linked to the Cause of Death Register maintained by the Swedish National Board of Health and Welfare. Suicides were ascertained from the death certificates.

Results

Seven of 14 patients who had died before April 2013 had committed suicide. The positive predictive value for the Suicide Intent Scale alone was 16.7 %, with a specificity of 52 % and an area under the curve of 0.74. A combined assessment with the KIVS gave higher specificity (63 %) and a positive predictive value of 18.8 % with an AUC of 0.83. Combined use of SIS and KIVS expressed interpersonal violence as an adult subscale gave a sensitivity of 83.3 %, a specificity of 80.3 %, and a positive predictive value of 26 % with an AUC of 0.85. The correlation between KIVS and SIS scores was not significant.

Conclusions

Using both the the SIS and the KIVS combined may be better for predicting completed suicide than using them separately. The nonsignificant correlation between the scales indicates that they measure different components of suicide risk.

【 授权许可】

   
2015 Stefansson et al.

【 图 表 】

Fig. 1.

【 参考文献 】

• [1]Tidemalm D, Långström N, Lichtenstein P, Runeson B: Risk of suicide after suicide attempt according to coexisting psychiatric disorder: Swedish cohort study with long-term follow-up. BMJ 2008, 337:a2205.
• [2]Runeson B, Tidemalm D, Dahlin M, Lichtenstein P, Långström N: Method of attempted suicide as predictor of subsequent successful suicide: national long-term cohort study. BMJ 2010, 341:c3222.
• [3]National Institute for Health and Care Excellence: Self-harm (longer term management. National Institute for Health and Care Excellence, London; 2011. [CG133]
• [4]Kendall T, Taylor C, Bhatti H, Chan M, Kapur N: Longer-term management of self-harm: summary of NICE guidance. BMJ 2011, 343:d7073-3.
• [5]Fowler JC: Suicide risk assessment in clinical practice: pragmatic guidelines for imperfect assessments. Psychother 2012, 49:81-90.
• [6]Posner K, Brown GK, Stanley B, Brent DA, Yershova KV, Oquendo MA, et al.: The Columbia–Suicide Severity Rating Scale: initial validity and internal consistency findings from three multisite studies with adolescents and adults. Am J Psychiatry 2011, 168:1266-1277.
• [7]Beck AT, Schuyler D, Herman I: Development of suicidal intent scales. In The Prediction of Suicide. Edited by Beck AT, Resnik HL, Lettieri DJ. Charles Press Publishers, Oxford, England; 1974:249.
• [8]Freedenthal S: Assessing the wish to die: a 30-year review of the suicide intent scale. Arch Suicide Res 2008, 12:277-298.
• [9]Stefansson J, Nordström P, Jokinen J: Suicide Intent Scale in the prediction of suicide. J Affect Disord 2012, 136:167-171.
• [10]O'Donnell O, House A, Waterman M: The co-occurrence of aggression and self-harm: systematic literature review. J Affect Disord 2015, 175C:325-350.
• [11]Asellus P, Nordström P, Nordström AL, Jokinen J: Cholesterol and the “Cycle of Violence” in attempted suicide. Psychiatry Res 2014, 215(3):646-50.
• [12]Jokinen J, Forslund K, Ahnemark E, Gustavsson JP, Nordström P, Åsberg M: Karolinska Interpersonal Violence Scale predicts suicide in suicide attempters. J Clin Psychiatry 2010, 71:1025-1032.
• [13]Amsel L, Mann JJ: Suicide risk assessment and the suicidal process approach. In In Understanding Suicidal Behaviour: The Suicidal Process Approach to Research, Treatment and Prevention. Edited by Appleby L. John Wiley & Sons, Chichester; 2001:163-181.
• [14]Rajalin M, Hirvikoski T, Jokinen J: Family history of suicide and exposure to interpersonal violence in childhood predict suicide in male suicide attempters. J Affect Disord 2013, 148(1):92-7.
• [15]Bilén K, Ponzer S, Ottosson C, Castrén M, Pettersson H: Deliberate self-harm patients in the emergency department: who will repeat and who will not? Validation and development of clinical decision rules. Emerg Med J 2013, 30:650-656.
• [16]Large M, Sharma S, Cannon E, Ryan C, Nielssen O: Risk factors for suicide within a year of discharge from psychiatric hospital: a systematic meta-analysis. Aust N Z J Psychiatry 2011, 45:619-628.
• [17]Szmukler G: Risk assessment for suicide and violence is of extremely limited value in general psychiatric practice. Aust N Z J Psychiatry 2012, 46:173-174.
• [18]Blasco-Fontecilla H, Delgado-Gomez D, Ruiz-Hernandez D, Aguado D, Baca-Garcia E, Lopez-Castroman J: Combining scales to assess suicide risk. J Psychiatr Res 2012, 46(10):1272-7.
• [19]Copeland WE, Wolke D, Angold A, Costello EJ: Adult psychiatric outcomes of bullying and being bullied by peers in childhood and adolescence. JAMA Psychiatry 2013, 70:419-426.
• [20]Dube SR, Anda RF, Felitti VJ, Chapman DP, Williamson DF, Giles WH: Childhood abuse, household dysfunction, and the risk of attempted suicide throughout the life span: findings from the Adverse Childhood Experiences Study. JAMA 2001, 286:3089-3096.
• [21]Klomek AB, Sourander A, Niemelä S, Kumpulainen K, Piha J, Tamminen T, et al.: Childhood bullying behaviors as a risk for suicide attempts and completed suicides: a population-based birth cohort study. J Am Acad Child Adolesc Psychiatry 2009, 48:254-261.
• [22]Dumais A, Lesage AD, Alda M, Rouleau G, Dumont M, Chawky N, et al.: Risk factors for suicide completion in major depression: a case–control study of impulsive and aggressive behaviors in men. Am J Psychiatry 2005, 162:2116-2124.
• [23]Stack S: Differentiating suicide ideators from attempters: violence – a research note. Suicide Life-Threat Behav 2014, 44:46-57.
• [24]Jokinen J, Forslund K, Nordström A-L, Lindqvist P, Nordström P: Suicide risk after homicide in Sweden. Arch Suicide Res 2009, 13:297-301.
• [25]Lambert SF, Copeland-Linder N, Ialongo NS: Longitudinal associations between community violence exposure and suicidality. J Adolesc Health 2008, 43:380-386.
• [26]Stenbacka M, Moberg T, Romelsjo A, Jokinen J: Mortality and causes of death among violent offenders and victims - a Swedish population-based longitudinal study. BMC Pub Health 2012, 12:38. BioMed Central Full Text
• [27]Moberg T, Nordström P, Forslund K, Kristiansson M, Åsberg M, Jokinen J: CSF 5-HIAA and exposure to and expression of interpersonal violence in suicide attempters. J Affect Disord 2011, 132:173-178.
• [28]Jokinen J, Chatzittofis A, Hellström C, Nordström P, Uvnäs-Moberg K, Åsberg M: Low CSF oxytocin reflects high intent in suicide attempters. Psychoneuroendocrinology 2012, 37:482-490.