JMIR Publications

ABSTRACT

Even though various types of suicidality are observed in clinical practice, suicidality is still considered a uniform concept. To be able to improve the differentiation of suicidality -and consequently the detection, and management of suicidality in all its’ forms- we developed a clinical differentiation model for suicidality and believe using the model to differentiate suicidality allows a more targeted assessment of suicidal conditions and use evidence based treatment. The earliest description of the model, and a proposal for research, was first presented in a book chapter. A detailed description of a research protocol as a follow up of the introduction of the model in the book-chapter, and the most recent, updated version of the model are presented in this paper. The differentiation model is based on the practical experience with suicidality we encountered in clinical practice, and it distinguishes between 4 subtypes of suicidality: 5) Perceptual desintegration (PD) 6) Primary depressive cognition (PDC) 7) Psychosocial turmoil (PT) 8) Inadequate communication (IC) We will test the validity of the subtypes. For the pilot study 25 cases and for the follow-up study 75 cases (derived from a database of 100 cases) of anonymized patients, presenting to emergency services with acute suicidal behaviour, will be reviewed. The summary and conclusions of the letters to the GP will be used for the study and independently reviewed by three psychiatrists and three nurse-scientists for absolute scores and dimensional/gradual scores. Intraclass Correlation Coefficients (ICC) for absolute and gradual scores will be calculated to examine the validity of the model. After completion, the results of the study will be discussed and feedback will be given to the raters. A follow-up study will be rolled out when the results of the pilot are promising and relevant. The theoretical roots of the model presented in this paper, stem from classic and contemporary theoretical models. Our experience is that everyone who worked with the model, found it straightforward to understand the concept, and/or easy to apply in clinical practice. Validation of the model was lacking unfortunately, making it difficult to apply -or use- the model on a larger scale, despite its’ potential to change the management, treatment and diagnosis of suicidal behaviour/suicidality. Because the model is easy to use and supports more tailored and precise treatment, our hypothesis is that application of the model will ultimately change the dynamics between practitioners (or anyone delivering care) and patients. Not just because practitioners will find it easier to put the suicidality and risks into context, but also because patients will feel more understood when practitioners have a better insight into the drivers of their suicidality. Additionally, the model can be used as a base to determine the” best fit” for any treatment strategy focused on various types of suicidal behaviour. And last but not least, the differentiation of suicidality may improve scientific research at different levels.