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Predicting Suicide

OLDHAM, JOHN M., MD

Journal of Psychiatric Practice®: July 2018 - Volume 24 - Issue 4 - p 219
doi: 10.1097/PRA.0000000000000319
From the Editor

Editor

July 2018. It is with great pleasure that we announce the winning entry of the Journal’s 2017 resident paper competition, by Dr Noha Abdel Gawad and her collaborators. This year’s competition was particularly challenging for our judges, because there were many excellent papers and more submissions than usual. We were happy that Dr Abdel Gawad could join the Editorial Board Meeting, held in May at the American Psychiatric Association Annual Meeting in New York, and she will serve as a guest member of the Board for a 1-year rotation. The winning paper, titled “Religious activity, psychotic features, and suicidality in 688 acute psychiatric inpatients,” is featured in this issue of the Journal. The problems related to suicide and the ever-vexing and elusive goal of identifying patients at highest risk of suicide have been the subject of many papers published by JPP through the years. This new study is particularly valuable, because one of its aims was to assess whether or not “religiosity” plays a role in connection with “suicidality.” The role of religion or, more broadly, spirituality, is well known to be an important consideration when evaluating a given patient’s potential risk for suicide, but the published literature formally focusing on this issue is quite limited. Abdel Gawad and colleagues studied spirituality using the Duke University Religion Index in 688 adult patients hospitalized in an acute psychiatric facility. They found that high religiosity scores were associated with less suicidal ideation, and that, in particular, high scores on “organized religious activity” and “internal religiosity” were associated with fewer suicide attempts. Although these results make intuitive sense, they also provide data to support the need to systematically assess the dimension of religion in our work with patients, a dimension that is not always included in our assessments of suicide risk.

Also, in this issue of the Journal, in a guest Law and Psychiatry column, Thomas Joiner and colleagues call our attention to a “Condition for Further Study” presented in Section III of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), that is, “Suicidal Behavior Disorder” (SBD). Similar forms of a suicide-specific diagnosis have been referred to as “Acute Suicidal Affective Disturbance” or as “Suicide Crisis Syndrome.” DSM-5 defines a patient with SBD as someone who has made a suicide attempt during the last 24 months and who does not meet criteria for nonsuicidal self-injury, with the act not initiated in a state of delirium or solely for a political or religious objective. Joiner and colleagues make the argument that “inclusion in the psychiatric nomenclature of a clinical syndrome associated with imminent risk of suicide would clarify discharge planning, improve safety planning, and thus mitigate legal liability for clinicians.” The conceptual shape of the definition they present is somewhat different than that of DSM-5-defined SBD, since it emphasizes rapid onset and high lethality. And, in fact, the case described by the authors is of a patient who made a suicide attempt 3 years before the index hospitalization, thus excluding him from a provisional diagnosis of SBD, which requires a history of a suicide attempt within the last 24 months. However, I’m quibbling a bit, since we are in provisional territory here, and our emphasis should be on the concept of a suicide-specific diagnosis, the defining details of which are still to be worked out. Joiner and colleagues argue in support of such a new diagnosis, and their argument is an important one for our serious consideration. However, there certainly was some controversy about such a new diagnosis during the deliberations of the DSM-5 Task Force. And, in that regard, and as a “preview of coming attractions,” our Law and Psychiatry columnist, Dr Hal Wortzel, is planning a “part 2” column for the Journal’s September issue, tentatively titled “The Potential Perils of a Suicide-Specific Diagnosis,” to bring our attention to some differing points of view.

JOHN M. OLDHAM, MD

Editor

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