CNS Clinical Trials Suicidality and Data Collection: Workshop Summary (2010) / Chapter Skim
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2 Data Collection and Optimization
2 Data Collection and Optimization
Pages 17-24
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From page 17... ...
The first was by Matthew Nock of Harvard University, who spoke about his epidemiological findings. Similar to the clinical trial data presented by Thomas Laughren, Nock's epidemiological findings revealed that suicide ideation is not a strong predictor of a suicide attempt (Nock et al., 2009a)
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From page 18... ...
Ideators with anxiety disorders and disorders of impulse control, such as conduct disorder and posttraumatic stress disorder, exceeded depression in their predictive power for making suicide attempts, according to a large, nationally representative epidemiology study of U.S. adults, the National Comorbidity Survey Replication (Nock et al., 2009a, 2009b)
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From page 19... ...
The key is to collect data closer to these events using real-time methods and/or patients' daily assessment of self-injurious thoughts and behaviors. This methodology draws from a concept known as ecological momentary assessment, a collective term referring to detailed investigation of several mental health features in real-time, such as affect, mood, and interpersonal behavior.
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From page 20... ...
Two additional items record incidence and frequency of previous suicide attempts. However, the SSI-C does not measure previous suicide ideation "at its worst point in the patient's life," which is the subject of a separate scale (SSI-W)
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From page 21... ...
Brown and collaborators found that the predictive validity of the SSI for current ideation on subsequent suicide attempts was poor. However, they also found that high scores on the SSI at the worst point in time since the participant's previous visit was a significant predictor of a repeat suicide attempt recorded at the 3-month visit.
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From page 22... ...
, it becomes clear that multiple factors must be at play. Depression or psychosis Objective state Life events Hopelessness/reasons for living Perception of depression Low norepinephrine/ Suicidal ideation HPA axis Subjective state and traits Suicidal planning Low serotonin activity Impulsivity/restraint Aggression Alcoholism, smoking, Impaired problem solving, substance abuse, head Suicidal act poor set changing, injury cognitive rigidity, negative perceptual sets FIGURE 2-1 A model of suicidal behavior.
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From page 23... ...
, and on psychometric measures of mood. The study found that blunting of cortisol and the worsening of mood, plus younger age, predicted subsequent suicide attempts in depressed patients with previous attempts.
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From page 24... ...
Those psychological traits, in turn, place these people at higher risk for suicidal behavior. In summary, Mann believes that biological markers such as low serotonin levels predict future completed suicide.
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