de Winter Remco F P, Meijer Connie M, Enterman John H, Kool-Goudzwaard Nienke, Gemen Manuela, van den Bos Anne T, Steentjes Danielle, van Son Gabrielle E, Hazewinkel Mirjam C, de Beurs Derek P, de Groot Marieke H
Mental Health Institute Rivierduinen, Leiden, Netherlands.
VU University, Section of Clinical Psychology, Amsterdam Public Health Research Institute, Amsterdam, Netherlands.
JMIR Res Protoc. 2023 Aug 11;12:e45438. doi: 10.2196/45438.
Even though various types of suicidality are observed in clinical practice, suicidality is still considered a uniform concept. To distinguish different types of suicidality and consequently improve detection and management of suicidality, we developed a clinical differentiation model for suicidality. We believe that the model allows for a more targeted assessment of suicidal conditions and improves the use of evidence-based treatment strategies. The differentiation model is based on the experience with suicidality that we have encountered in clinical practice. This model distinguishes 4 subtypes of entrapment leading to suicidality. The earliest description of this model and a proposal for usability research has been previously presented in a book chapter.
In this study, we present the most recent version of the 4-type differentiation model of suicidality and a protocol for a study into the usability of the proposed model.
The 4-type differentiation model of suicidality distinguishes the following subtypes: (1) perceptual disintegration, (2) primary depressive cognition, (3) psychosocial turmoil, and (4) inadequate coping or communication. We plan to test the usability of the 4 subtypes in a pilot study of 25 cases, and subsequently, we will include 75 cases in a follow-up study. We looked at the case notes of 100 anonymized patients with suicidality who presented to mental health care emergency service in The Hague International Center. The summary and conclusions of the letters sent to the patients' general practitioners after suicide risk assessment will be independently rated by 3 psychiatrists and 3 nurse-scientists for absolute and dimensional scores. The Suicidality Differentiation version 2 (SUICIDI-II) instrument, developed for this study, is used for rating all the cases. Intraclass correlation coefficients for absolute and dimensional scores will be calculated to examine type agreement between raters to examine the usability of the model and the feasibility of the SUICIDI-II instrument.
We consider the model tentatively valid if the intraclass correlation coefficients are ≥0.70. Subsequently, if the model turns out to be valid, we plan to rate 75 other cases in a follow-up study, according to a similar or adjusted procedure. Study results are expected to be published by the end of 2023.
The theoretical roots of the differentiation model stem from classic and contemporary theoretical models of suicidality and from our clinical practice experiences with suicidal behaviors. We believe that this model can be used to adjust the diagnosis, management, treatment, and research of suicidality, in addition to distinguishing different dynamics between practitioners and patients with suicidality and their families.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/45438.
尽管在临床实践中观察到了各种类型的自杀倾向，但自杀倾向仍被视为一个统一的概念。为了区分不同类型的自杀倾向，从而改善对自杀倾向的检测和管理，我们开发了一种自杀倾向的临床鉴别模型。我们认为该模型能够更有针对性地评估自杀状况，并改善基于证据的治疗策略的应用。该鉴别模型基于我们在临床实践中遇到的自杀倾向经验。此模型区分了导致自杀倾向的4种被困亚型。该模型的最早描述以及可用性研究的建议先前已在一本书的章节中提出。
在本研究中，我们展示了自杀倾向4型鉴别模型的最新版本以及对所提模型可用性研究的方案。
自杀倾向4型鉴别模型区分以下亚型：（1）感知解体，（2）原发性抑郁认知，（3）心理社会动荡，以及（4）应对或沟通不足。我们计划在一项25例的试点研究中测试这4种亚型的可用性，随后，我们将在后续研究中纳入75例。我们查看了100例在海牙国际中心心理健康护理紧急服务部门就诊的匿名自杀倾向患者的病历。在自杀风险评估后发给患者全科医生的信件的总结和结论将由3名精神科医生和3名护士科学家独立评分，以得出绝对分数和维度分数。为本研究开发的自杀倾向鉴别版本2（SUICIDI-II）工具用于对所有病例进行评分。将计算绝对分数和维度分数的组内相关系数，以检查评分者之间的类型一致性，从而检验模型的可用性和SUICIDI-II工具的可行性。
如果组内相关系数≥0.70，我们认为该模型初步有效。随后，如果该模型被证明有效，我们计划根据类似或调整后的程序在后续研究中对另外75例进行评分。研究结果预计在2023年底公布。
鉴别模型的理论根源源于经典和当代自杀倾向理论模型以及我们对自杀行为的临床实践经验。我们相信，除了区分自杀倾向从业者与患者及其家属之间的不同动态外，该模型还可用于调整自杀倾向的诊断、管理、治疗和研究。
国际注册报告识别码（IRRID）：DERR1-10.2196/45438。
