Poster Index

Ethical and methodological challenges and solutions in suicide research

Clinical and neurocognitive studies of suicidal behavior (17)  |  Clinical phenotyping of suicidal individuals (23)
Culture, ethnicity and spiritual approaches. New paradigms in suicidology (11)  |  Ethical and methodological challenges and solutions in suicide research (5)
Genetic, epigenetic and gene expression contributors to suicide risk (2)  |  Intervention research for prevention of suicidal behavior (30)
Lifespan differential aspects (from infancy to elderly) (7)  |  Miscellany (assisted suicide, minorities, legal aspects, etc.) (9)
Neurobiological underpinnings of suicidal behavior (3)  |  Novel monitoring strategies for detecting changes in risk over time (4)
Psychosocial variables: protective and risk factors. Resilience & vulnerability (38)  |  Testing the effectiveness of prevention strategies (6)




Ethical and methodological challenges and solutions in suicide research


(8) PO-8. Misdiagnosing non-suicidal and suicidal behavior

Day: 10 | Time: 13:30 | Room: Poster Hall

Topic: Ethical and methodological challenges and solutions in suicide research

Authors:Tobias Teismann . Department of Clinical Psychology & Psychotherapy, Ruhr-Universität Bochum, Bochum, Germany
- Jan Cwik -

 Introduction:
Inconsistent nomenclature and classification of suicidal behavior has plagued the field of suicidology for a long time. To enhance interpretability of self-directed violence within pediatric antidepressant trial data the Columbia Classification Algorithm of Suicide Assessment (C-CASA; Posner et al., 2007), a classification system that utilizes definitions of self-injurious events rooted in consensus recommendations and empirical findings on the phenomenology of non-suicidal and suicidal behaviour, was developed.
 Goals:
Aim of the current study was to determine the extent of misdiagnosed acts of self-directed violence according to the C-CASA classification system ? controlling for the level of expertise in psychology/psychotherapy. Additionally, the effect of gender and diagnosis on misclassifications was assessed.
 Methodology:
426 participants (laypersons, psychology students, psychotherapists-in-training, licensed psychotherapists) were presented with 15 case vignettes describing different acts of self-injurious behavior (e.g., non-suicidal self-injury, suicide attempt, suicide ideation) and were asked to make a classification. Gender and given diagnosis (Major Depression vs. Borderline Personality Disorder) were varied systematically in two vignettes.
 Results:
Overall 51.6% of the cases were misclassified (Range: 0.5% to 71.6%). The level of expertise was almost unrelated to classification correctness. Yet, psychotherapists were more confident about their judgments. Female gender of the character described in the vignette and an ascribed diagnosis of Borderline Personality Disorder were associated with higher misclassification rates.
 Conclusions:
The results highlight the importance of more methodological and diagnostic training of psychologists regarding suicidal issues. This is even more relevant considering the potentially severe consequences of misclassifications for patients as well as their therapists.
 References:
Posner, K., Oquendo, M., Gould, M., Stanley, B., Davies, M., 2007. Columbia classification algorithm of suicide assessment (C-CASA): Classification of suicidal events in the FDA´s pediatric suicidal risk analysis of antidepressants. Am. J. Psychiatry 164, 1035?1043.


(113) PO-113. The Web-Based Assessment of Suicidal and Suicide-Related Symptoms: Factors Associated with Disclosing Identifying Information to Receive Study Compensation

Day: 09 | Time: 13:30 | Room: Poster Hall

Topic: Ethical and methodological challenges and solutions in suicide research

Authors:Melanie Hom . Florida State University, Tallahassee, FL - United States
- Ian Stanley - Thomas Joiner -

 Introduction:
With the increasing utilization of web-based surveys for suicide and suicide-related research, it is critical to understand factors that impact participants? decision to request study compensation (and thus potentially reveal their identity) or remain anonymous.
 Goals:
This study evaluated differences in demographics, suicidal symptoms, and suicide-related constructs between participants electing and declining to provide identifying information to receive study compensation.
 Methodology:
A sample of 931 firefighters (91.5% male) participated in a web-based mental health survey; upon survey completion, individuals had the option to provide contact information to receive a $10 gift card. Logistic regression analyses were employed to investigate differences between those who did and did not provide this information.
 Results:
Overall, 82.8% provided identifying information, with younger individuals significantly more likely to do so. Participants reporting more severe suicidal symptoms and greater levels of suicide-related constructs appeared equally, and in some cases, significantly more, willing to provide identifying information.
 Conclusions:
Findings indicate that individuals reporting more sensitive or stigmatizing experiences may not systematically opt-out of receiving study compensation to remain anonymous on web-based surveys. Additional research is warranted to replicate these findings in more representative samples and further delineate personality and other factors influencing the disclosure of contact information to receive study compensation.
 References:
1. American Psychological Association [APA]. Ethical principles of psychologists and code of conduct. American Psychological Association, editor. Washington, D.C.; 2010.
2. Podlogar MC, Rogers ML, Chiurliza B, Hom MA, Tzoneva M, Joiner TE. Who are we missing? Non-disclosure in online suicide risk screening questionnaires. Psychol Assess. 2015.


(327) PO-327. Attitudes towards euthanasia among relatives in psychiatry

Day: 09 | Time: 10:30 | Room: Poster Hall

Topic: Ethical and methodological challenges and solutions in suicide research

Authors:August G. Wang . Centre of Suicide Prevention, Copenhagen University Hospital, Copenhagen, Denmark
- Titia Lahoz -

 Introduction:
Assisted suicide and euthanasia are often topics in public debate, but not so often in psychiatric congresses or journals. However, the trend in some countries indicate that the movement for the "right to die" or a "dignified death" also will reach psychiatric patients. Some studies or surveys about the attitude towards assisted suicide and euthanasia are often conducted in general public, and thus do not reveal the attitude in populations that are patients or relatives to patients where death or suicide is a real potential option.
 Goals:
We want to elucidate the attitude among relatives to elderly psychiatric patients, which is a group of people that may consider death and suicide as a solution.
 Methodology:
Psychiatric patients 65 or older are asked for permission to interview one relative. The relatives are interviewed about: Age, sex, relation to the patient, at work or pensioneer, percieved burden of care, attitude toward influence on and involvement in patients´ treatment, attitude towards a law legalising assisted suicide and/or euthanasia.
 Results:
So far we have only some few results, but we intend to present results about relatives´ attitude towards assisted suicide and/or euthanasia, possible related to age, sex and relation to patient, burden of care, influence and involvement in treatment.
 Conclusions:
Results will be discussed for relatives that have patients that potentially could ask for assisted suicide or for euthanasia. Also how relatives´ own age, sex, relation to patient and influence on and involvement in treatment possible can influence the attitude.
 References:
Stutzki R1, Weber M, Reiter-Theil S, Simmen U, Borasio GD, Jox RJ. Attitudes towards hastened death in ALS: a prospective study of patients and family caregivers. Amyotroph Lateral Scler Frontotemporal Degener. 2014 Mar;15(1-2):68-76.


(364) PO-364. Surveillance of Youth Self-Directed Violent Behavior in Hospital Settings

Day: 10 | Time: 13:30 | Room: Poster Hall

Topic: Ethical and methodological challenges and solutions in suicide research

Authors:Thomas Delaney . University of Vermont, Burlington, USA
- Laurin Kasehagen - Barbara Carroll -

 Introduction:
youth self-directed violence (sdv) is believed to be prevalent and may be increasing, but systematic data on sdv are lacking.1 Effective sdv prevention requires identification of populations and individuals who experience different types of sdv. using hospital discharge data, we identified youth self-directed violent behaviors and estimated corresponding population rates of suicidal ideation, suicidal and undetermined sdv, and medicinal poisonings.
 Goals:
identify a common set of billing codes for identifying specific sdv behaviors, and estimate population rates of undetermined and suicidal sdv in young people.
 Methodology:
we used external cause-of-injury international classification of diseases, ninth revision, clinical modification (icd-9) codes for suicidal ideation, undetermined and intentional injuries, medicinal poisonings, and mental health conditions to define a common set of codes relevant to youth with suicidal ideation and self-directed violent behaviors.2 we then analyzed data from the vermont uniform hospital discharge data sets to estimate and describe population rates of suicidal ideation and sdv.
 Results:
analysis included 6008 2010-2014 emergency departments visits for ages 10-24 with icd-9 codes for suicidal ideation, suicidal and undetermined sdv, and medicinal poisonings. Crude rates of ideation, sdv, and medicinal poisonings increased – 23.7 to 29.0, 22.8 to 32.3, and 13.3 to 16.4, per 10,000 population, respectively. disparities were observed among youth and hospital visit characteristics by episode type.
 Conclusions:
icd 9 coding for self-directed violence in youth can be used to estimate specific sdv behaviors, and examine changes of these behaviors over time. youth sdv appears to have increased since 2010.
 References:
1. patrick ar, miller m, barber cw, et al. identification of hospitalizations for intentional self-harm when e-codes are incompletely recorded. pharmacoepidemiol drug saf. 2010;19:1263-1275. 2. crosby ae, ortega l, melanson c. self-directed violence surveillance: uniform definitions and recommended data elements, version 1.0. atlanta (ga): centers for disease control and prevention, national center for injury prevention and control; 2011


(373) PO-373. Practices and difficulties of health professionals towards suicidal patients

Day: 10 | Time: 13:30 | Room: Poster Hall

Topic: Ethical and methodological challenges and solutions in suicide research

Authors:Ines Rothes . Faculty of Psychology and Educational Sciences of Porto University, Portugal , Porto
-

 
 Goals:
The study describes the current practices and difficulties of psychologists, psychiatrists and general physician facing a suicidal patient and tests differences according to socio-professional variables as training in suicide prevention.
 Methodology:
242 health professionals filled out self-report questionnaires: the ISBQ - Intervention Strategies towards Suicidal Behaviours Questionnaire and the DSBQ - Difficulties in Suicidal Behaviors Intervention Questionnaire. Exploratory principal components and variance analyses were used.
 Results:
Five intervention components emerged: comprehensive assessment; protocols; family; psychotherapy; and hospitalization and medical treatment; and four types of difficulties were found: technical; emotional; relational and communicational; and family-approaching and logistic difficulties. Psychotherapy is the modality of treatment most likely to be advised; health professionals rated the support to the family, the hospitalization and medical treatment, including pharmacological therapy with moderate probability to be counselled. The use of protocols is unlikely even if more probable by psychologists. The comparison of psychologists, psychiatrists and GPs revealed moderate to large differences in practices and difficulties. Psychiatrists reported as more likely to engage in risk detection and assessment than psychologists and GPs. The professionals who have specific training on suicide intervention tend to score higher in the assessment practices and in the involvement of the family and tend to achieve lower scores in difficulties. The specific experience with suicidal behaviours in clinical practice also influences the assessment practices and technical and emotional difficulties: the more experience with suicidal patients the greater the likelihood to perform a comprehensive evaluation and to feel fewer difficulties.
 Conclusions:
Health professionals’ practices can benefit from specific training namely using case base learning and other experiential and active methodologies.