Concordancia del autorreporte y la valoración clínica de la ideación suicida

Abstract

Background

Thoughts of suicide and/or death usually precede suicide attempts and suicide deaths. We study the agreement in passive suicidal ideation between reports made by clinicians during an outpatient mental health service and patients’ online self-reports.

Methodology

Between 2014 and 2016, during routine psychiatric and psychological appointments in the outpatient mental-health facilities affiliated with the Fundación Jiménez Díaz Hospital in Madrid, wish of death was assessed in 25.358 patients.

Within 24 hours of this assessment, 648 patients completed a self-report in which they were asked about the presence of passive suicidal ideation. We used cluster analysis to determine the clinical profile of a population of patients according to the agreement between reports made by clinicians and self-reported information.

Results

A low level of agreement (kappa = 0.072) was found between clinicians and patients, as 56.4% (n = 366) of clinicians’ reports classified as containing no death-related ideas, although on self-report the patient did state that they had passive suicidal ideation. In this group, two clusters (cluster 2 y 4) were found to have shared characteristics: female sex, middle age, cohabitation, active employment, no history of suicidal behavior, and diagnosis of neurotic, stress-related, and somatoform disorders. Additionally, cluster 4 patients self-reported sleep disturbances, less appetite, poor treatment adherence, and aggressiveness.

Conclusions

We found low agreement between patients’ self-reports and clinician assessments regarding the passive suicidal ideation. Self-report may be useful in suicide risk assessment as a complementary method, that allows to generate a confidential space that could reduce the problem of underreporting of passive suicidal ideation.