Identifying subtypes of suicidality: a second larger consensus study in emergency clinical psychiatric practice

Area of Science:

• Mental Health
• Psychiatry
• Clinical Psychology

Background:

• A novel model, the (hypothetical) 4-type Model of Entrapment ((h)4ME), has been developed to classify distinct pathways to suicidality.
• The (h)4ME model identifies four subtypes: Perceptual Disintegration (PD), Primary Depressive Cognition (PDC), Psychosocial Turmoil (PT), and Inadequate Coping/Communication (IC).

Purpose of the Study:

• To evaluate the usability and feasibility of the (h)4ME model in a larger cohort of suicidal patients.
• To assess the reliability of the SUICIDI-3 tool in categorizing patients into the proposed subtypes.

Main Methods:

• Consultation reports from 75 suicidal emergency patients were independently reviewed by psychiatrists and nurses.
• The SUICIDI-3 tool was used to allocate cases to the four subtypes defined by the (h)4ME model.
• Interrater agreement was calculated using Intraclass Correlation Coefficients (ICCs) to assess absolute and dimensional type agreement.

Main Results:

• All raters successfully assigned cases to subtypes, indicating high usability.
• Excellent absolute Type Agreement (aTA) was found for Perceptual Disintegration (0.96) and Primary Depressive Cognition (0.92).
• Good aTA was observed for Psychosocial Turmoil (0.83) and Inadequate Coping/Communication (0.83), with similar high ICC scores for dimensional agreement.

Conclusions:

• The (h)4ME model demonstrates promising usability and feasibility for classifying suicidality subtypes in psychiatric emergency settings.
• Further replication studies with diverse patient populations and professional backgrounds are recommended to confirm these findings.