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Method of assessment determines prevalence of suicidal ideation among patients with depression

Published online by Cambridge University Press:  15 April 2020

M. Vuorilehto ,
H.M. Valtonen ,
T. Melartin ,
P. Sokero ,
K. Suominen  and
E.T. Isometsä
M. Vuorilehto
Affiliation:
Department of Mental Health and Alcohol Research, National Institute for Health and Welfare, Helsinki, Finland Department of Psychiatry, Helsinki University Central Hospital P.O. Box 590, 00029, HUS
H.M. Valtonen
Affiliation:
Department of PsychiatryCity of Helsinki, Health Centre, Psychiatry, Helsinki, Finland
T. Melartin
Affiliation:
Department of Mental Health and Alcohol Research, National Institute for Health and Welfare, Helsinki, Finland Department of Psychiatry, Helsinki University Central Hospital P.O. Box 590, 00029, HUS
P. Sokero
Affiliation:
Department of Mental Health and Alcohol Research, National Institute for Health and Welfare, Helsinki, Finland
K. Suominen
Affiliation:
Department of PsychiatryCity of Helsinki, Health Centre, Psychiatry, Helsinki, Finland
E.T. Isometsä*
Affiliation:
Department of Mental Health and Alcohol Research, National Institute for Health and Welfare, Helsinki, Finland Department of Psychiatry, Helsinki University Central Hospital P.O. Box 590, 00029, HUS Department of Psychiatry, University of Helsinki, Institute of Clinical Medicine, P.O. Box 22, FIN-00014, Finland
*
*Corresponding author. Tel.: +358 9 471 63728; fax: +358 9 47163735. E-mail address:erkki.isometsa@hus.fi, erkki.isometsa@helsinki.fi (E.T. Isometsä).
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Abstract

Background

How different ways of assessing suicidal ideation influence its prevalence, correlates and predictive validity among patients with major depressive disorder (MDD) remains unclear.

Methods

Within the Vantaa Primary Care Depression Study (PC-VDS, 91 patients) and the Vantaa Depression Study (VDS, 153 psychiatric out-and 41 inpatients), suicidal ideation was assessed with the Scale for Suicidal Ideation (SSI), Hamilton Depression Scale (HAM-D) item 3 and Beck Depression Inventory (BDI) item 9, and by asking whether patients had seriously considered suicide during the episode. The positive and negative predictive values (PPV, NPV) for suicide attempts during a six-month follow-up were investigated.

Results

Depending on the setting, 56–88% of patients had suicidal ideation in some of the assessments, but only 8–44% in all of them. Agreement ranged from negligible to moderate (kappa 0.06–0.64), being lowest among primary care patients. The correlates of suicidal ideation overlapped. No assessment had optimal sensitivity, specificity, PPV and NPV. Nevertheless, PPVs ranged up to 43%.

Conclusions

Which MDD patient is classified as having suicidal ideation depends strongly on the method of assessment, with the greatest variation likely in primary care. Differences in assessments may cause inconsistency in risk factors. Predicting suicide attempts is difficult, but not futile.

Keywords

Major depressive disorderSuicidal ideationSuicide attemptsSuicidePrimary health carePsychiatric care
Type
Original article
Information
European Psychiatry , Volume 29 , Issue 6 , August 2014 , pp. 338 - 344
Copyright
Copyright © Elsevier Masson SAS 2014

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