Identifying Subtypes of Suicidality: A Second Validation Study in Emergency Clinical Psychiatric Practice

Abstract Background: For clinical practice in mental health care, a differentiation model for subtypes of pathways to entrapment leading to suicidality was developed. The hypothetical four type model of entrapment (h)4ME model) displays four subtypes of entrapment: I)​ ​perceptual disintegration (PD), II)​ ​primary depressive cognition (PDC), III) psychosocial turmoil (PT) and IV) inadequate coping/ communication (IC). Objective We aim to examine the model’s usability and feasibility after evaluation of a former pilot study in a larger cohort of suicidal patients (n=75). Methods: Consultation reports to general practitioners of 75 cases of anonymized suicidal emergency patients were independently reviewed by three psychiatrists and three nurses (raters). Using the SUICIDI​-3​ questionnaire describing the proposed subtypes, cases were allocated by raters. Intraclass Correlation Coefficients (ICC) for absolute and dimensional type agreement of raters were calculated to examine the model’​s​ usability and the tool’s feasibility. Results: All raters were able to assign cases to subtypes. We found excellent reliability for PD (0·96) and PDC (0·92), and good reliability for PT (0·83) and IC (0·83). For absolute interrater agreement. For dimensional interrater agreement, we found excellent reliability for PD (0·97), PDC (0·95), IC 0·92), and a good reliability for PT (0·88). Conclusions The 4ME model shows promising results with respect to its validity. Follow-up studies however, including variable samples of participants in various contexts, and with raters of various origin may show the consistency of the findings.