Presentation on theme: "Concerning the suitability of the Symptom-Check-List (SCL-90-R) for the diagnosis of acute suicidality Mangholz, Astrid & Manfred Kuda Center for psychological."— Presentation transcript:
Concerning the suitability of the Symptom-Check-List (SCL-90-R) for the diagnosis of acute suicidality Mangholz, Astrid & Manfred Kuda Center for psychological medicine – Psychotherapeutical ambulance for university students University of Göttingen Germany
Poster presented at the 37th Annual Meeting of the Society for Psychotherapy Research Edinburgh, 2006
For the meantime, the SCL-90-R (Derogatis, 1986; Franke, 1995) is a very frequently used diagnostic instrument in psychotherapeutical outpatient clinics, psychosomatical and psychiatrical hospitals. In the basis documentation of the psychotherapeutical outpatient clinics for students examined by us, it has been rather used so far as a screening-procedure Since the student clientele is subject to a clear suicide risk (a.o. Kuda, 2004), we follow the question whether, and in which degree, the SCL-90 (and/or parts from it) is suitable for diagnosing the acute suicidality of this clientele.
Here examined: 1. whether the estimation of suicidality by the clients corresponds with that by the psychotherapists. 2. hether the estimation of acute suicidality by the clients corresponds with the therapist diagnoses of future suicide-danger. 3. whether there are connections between personality-characteristics of the clients and the estimations of suicidality by clients and therapists.
Criteria of suicidality are A - from the clients view: Questionnaire test of suicidal – depressive tendencies (FBS, Stork, 1974) Item 15 of the SCL: Have you had thoughts of taking your own life… in the past 7 days to today? B - from the psychotherapist´s view: Marking of acute suicidality on a list of 40 single symptoms. Prognosis estimation of the future suicide-danger on a 7-stage scale from "not at all" to "very strongly"
Fig. 1: Characteristics of the sample-test N1998 / 99 155 2001 210 Sex (%) 43,2 56,8 40,3 59,7 Age (in years) AM25,7 4,1 19-39 25,9 4,1 19-44 SD from – to (in years) University terms AM SD from – to 9,89 6,2 1-34 8,99 5.0 1-31
Fig. 2: Suicide-criteria – from the clients view 1998 / 992001 SCL-item 15: Have you had thoughts of taking your own life… in the past 7 days? (%) not at all58,764,3 a little25,819,0 quite5,24,8 strongly6,57,6 very strongly3,93,3
Fig. 3: Suicide-criteria – from the clients view Questionnaire-test about the Estimation of suicide-danger (FBS-Total Score) 1998 / 992001 Category (in %): normality55,662,3 normality doubtful16,319,2 weak suicide-danger18,912,5 strong suicide-danger8,56,0 particularly strong suicide-danger 0,7- AM SD 28,0 9,7 26,3 9,1
Fig. 4: Suicide-criterion – Psychotherapists prognosis of future suicide- risk (in %) 1998 / 992000 / 01 Not at all 127,748,0 235,427,0 322,37,4 46,10,7 57,74,6 60,86,1 Very 7 strongly -6,1
To question 1: It was examined whether the estimation of sucidality by the clients corresponds with that by the psychotherapists The self-assessment of acute suicidality is significantly connected, at least as a trend with the therapists criteria in significant correlation Most strongly with the diagnosis "suicidality" in the newer sample The long - lasting suicidal tendencies (FBS) show non-conforming results: In the older sample-test they are linked in a highly-significant way with an unfavourable prognosis In the newer sample-test they tend towards the therapists diagnosis suicidality
Fig. 5: Intercorrelation of the suicide –criteria Psychotherapists PrognosisSuicide Clientssuicide riskIdeas FBS-Total score.291 **.053.091.167 (*) SCL-15 Item.168 *).174 *.147 (*).334 ** (acute Suicide- Tendencies _________________________________________ (*) p <.10; * p <.05; ** p <.01 Uppwer row: 1998/99 Lower row: 2000/01
To question 2: It was examined whether the estimation of acute sucidality by the clients corresponds with the prognoses of future suicide-danger by the therapists In the older sample all suicide-criteria are linked with a more unfavourable therapists diagnosis of future suicide-danger In the newer sample, not at all
To question 3: It was examined whether there are correlations between personality-characteristics of the clients and the estimations of suicidality by clients and therapists The self-assessment of acute suicidality (SCL-15) is, in both samples linked with more negative social resonance (GT-1) and higher depressive general mood (GT-4) in a weakly to highly significant relationship Also in the newer sample-test additionally with pronounced retentivity (GT-5) and/or smaller permeability The long-lasting suicidal-depressive tendencies (FBS) are linked with all personality-characteristics (via GT), except subcontrol vs. coercion (GT-3), in a significant to highly significant way
Discussion In the comparison of the two periods the results are not the same, partly unexpectedly Correspondence exists in the social-biographic characteristics: The suicide-criteria from the clients view are nearly identically Distributed the average therapists prognoses of suicidality are alike Overlaps are found in the symptom-frequency, but also differences: Twice as many sleep disturbances in the newer sample; Clearly fewer partner problems, as well as Problems with the family of origin The inter-correlations of the suicide-criteria are non-uniform in both periods: The prognosis of future suicidality does not have important relations with these criteria in the newer sample the suicide-criteria from the therapists view have nearly no connection with the personality-characteristics in the newer sample.
Corresponding adress: Dr. Manfred Kuda (firstname.lastname@example.org), Burg Grona email@example.com D - 37079 Göttingen