Hidetoki Ishii

Psychiatric disorders and clinical correlates of suicidal patients admitted to a psychiatric hospital in Tokyo

BackgroundPatients admitted to a psychiatric hospital with suicidal behavior (SB) are considered to be especially at high risk of suicide. However, the number of studies that have addressed this patient population remains insufficient compared to that of studies on suicidal patients in emergency or medical settings. The purpose of this study is to seek features of a sample of newly admitted suicidal psychiatric patients in a metropolitan area of Japan.Method155 suicidal patients consecutively admitted to a large psychiatric center during a 20-month period, admission styles of whom were mostly involuntary, were assessed using Structured Clinical Interviews for DSM-IV Axis I and II Disorders (SCID-I CV and SCID-II) and SB-related psychiatric measures. Associations of the psychiatric diagnoses and SB-related characteristics with gender and age were examined.ResultsThe common DSM-IV axis I diagnoses were affective disorders 62%, anxiety disorders 56% and substance-related disorders 38%. 56% of the subjects were diagnosed as having borderline PD, and 87% of them, at least one type of personality disorder (PD). SB methods used prior to admission were self-cutting 41%, overdosing 32%, self-strangulation 15%, jumping from a height 12% and attempting traffic death 10%, the first two of which were frequent among young females. The median (range) of the total number of SBs in the lifetime history was 7 (1-141). Severity of depressive symptomatology, suicidal intent and other symptoms, proportions of the subjects who reported SB-preceding life events and life problems, and childhood and adolescent abuse were comparable to those of the previous studies conducted in medical or emergency service settings. Gender and age-relevant life-problems and life events were identified.ConclusionsFeatures of the studied sample were the high prevalence of affective disorders, anxiety disorders and borderline PD, a variety of SB methods used prior to admission and frequent SB repetition in the lifetime history. Gender and age appeared to have an influence on SB method selection and SB-preceding processes. The findings have important implications for assessment and treatment of psychiatric suicidal patients.

Post-hospitalization course and predictive signs of suicidal behavior of suicidal patients admitted to a psychiatric hospital: a 2-year prospective follow-up study

BackgroundSuicidal patients admitted to a psychiatric hospital are considered to be at risk of suicidal behavior (SB) and suicide. The present study aimed to seek predictors of SB recurrence of the high-risk patients by examining their post-hospitalization course.MethodThe design was 2-year prospective follow-up study of patients consecutively admitted with SB to a psychiatric center in Tokyo. The DSM-IV diagnoses and SB-related features of subjects were determined in structured interviews. Subsequently, the subjects underwent a series of follow-up assessments at 6-month intervals. The assessment included inquiries into SB recurrence, its accompanying suicidal intent (SI) and SF-8 health survey. Analyses of serial change over time in the follow-up data and Cox proportional hazards regression analyses of SB recurrence were performed.Results106 patients participated in this study. The dropout rate during the follow-up was 9%. Within 2 years, incidences of SB as a whole, SB with certain SI (suicide attempt) and suicide were 67% (95% CI 58 - 75%), 38% (95% CI 29 - 47%) and 6% (95% CI 3 - 12%), respectively. Younger age, number of lifetime SBs and maltreatment in the developmental period were predictive of SB as a whole, and younger age and hopelessness prior to index admission were predictive of suicide attempt. Regarding diagnostic variables, anxiety disorders and personality disorders appeared to have predictive value for SB. Additionally, poor physical health assessed during the follow-up was indicated as a possible short-term predictor of SB recurrence.ConclusionsThis study demonstrated a high incidence of SB and suicide and possible predictors of SB recurrence in the post-hospitalization period of psychiatric suicidal patients. Specialized interventions should be developed to reduce the suicide risk of this patient population.

Pathways from life-historical events and borderline personality disorder to symptomatic disorders among suicidal psychiatric patients: A study of structural equation modeling.

Suicidal behavior (SB) is a major mental health problem. The research has identified many factors related to SB, such as problems in the developmental period and psychiatric and personality disorders. However, the interrelation of these factors has not been clearly delineated.

Motivation factors for suicidal behavior and their clinical relevance in admitted psychiatric patients

Background Suicidal behavior (SB) is a major, worldwide health concern. To date there is limited understanding of the associated motivational aspects which accompany this self-initiated conduct. Aims To develop a method for identifying motivational features associated with SB by studying admitted psychiatric patients, and to examine their clinical relevance. Methods By performing a factor analytic study using data obtained from a patient sample exhibiting high suicidality and a variety of SB methods, Motivations for SB Scale (MSBS) was constructed to measure the features. Data included assessments of DSM-IV psychiatric and personality disorders, suicide intent, depressive symptomatology, overt aggression, recent life events (RLEs) and methods of SB, collated from structured interviews. Association of identified features with clinical variables was examined by correlation analyses and MANCOVA. Results Factor analyses elicited a 4-factor solution composed of Interpersonal-testing (IT), Interpersonal-change (IC), Self-renunciation (SR) and Self-sustenance (SS). These factors were classified according to two distinctions, namely interpersonal vs. intra-personal directedness, and the level of assumed influence by SB or the relationship to prevailing emotions. Analyses revealed meaningful links between patient features and clinical variables. Interpersonal-motivations (IT and IC) were associated with overt aggression, low suicidality and RLE discord or conflict, while SR was associated with depression, high suicidality and RLE separation or death. Borderline personality disorder showed association with IC and SS. When self-strangulation was set as a reference SB method, self-cutting and overdose-taking were linked to IT and SS, respectively. Conclusions The factors extracted in this study largely corresponded to factors from previous studies, implying that they may be useful in a wider clinical context. The association of these features with SB-related factors suggests that they constitute an integral part of the process leading to SB. These results provide a base for further research into clinical strategies for patient management and therapy.

Reliability and Validity of a Shortened Version of an Instrument for Diabetes Self-Care Agency.

Purpose: The purpose of this study was to develop a shortened version of the Instrument of Diabetes Self-Care Agency (IDSCA). Methods: In the development of the shortened version of IDSCA, intraclass correlation coefficient 2 (ICC2) analysis was done to determine items to be deleted. However, the 7 subscales were retained. The shortened IDSCA was evaluated for internal consistency, reproducibility, concurrent validity, criterion-related validity, and goodness of fit. Results: The shortened IDSCA included 35 items addressing 7 subscales. High ICC2 (.804) and a high Cronbach’s alpha (.89) indicate internal consistency and reproducibility. A high correlation (.62) between the shortened version of the IDSCA and the Self-Care Agency Questionnaire indicated concurrent validity. Conclusion: The shortened IDSCA provides a reliable and valid measure of self-care agency of individuals with diabetes.

A Bayesian predictive analysis of test scores

In the classical test theory, a high-reliability test always leads to a precise measurement. However, when it comes to the prediction of test scores, it is not necessarily so. Based on a Bayesian statistical approach, we predicted the distributions of test scores for a new subject, a new test, and a new subject taking a new test. Under some reasonable conditions, the predicted means, variances, and covariances of predicted scores were obtained and investigated. We found that high test reliability did not necessarily lead to small variances or covariances. For a new subject, higher test reliability led to larger predicted variances and covariances, because high test reliability enabled a more accurate prediction of test score variances. Regarding a new subject taking a new test, in this study, higher test reliability led to a large variance when the sample size was smaller than half the number of tests. The classical test theory is reanalyzed from the viewpoint of predictions and some suggestions are made.

Structural model of self‐care agency in patients with diabetes: A path analysis of the Instrument of Diabetes Self‐Care Agency and body self‐awareness

Aim The aim of this study was to examine a causal model of self‐care agency by exploring the relationship between the structure of “body self‐awareness” and the structure of the Instrument of Diabetes Self‐Care Agency (IDSCA). Methods The participants were 353 patients with diabetes. The internal consistency of the six items for body self‐awareness was examined by calculating the factor structure using principal factor analysis and Cronbachs alpha. In order to examine the relationship between the seven factors in the IDSCA, a path analysis was conducted. Results With regard to the factor structure, the factor loading of these five items was 0.511–0.743 (α = 0.739). In the path analysis, “body self‐awareness” was influenced by the “ability to acquire knowledge” and had a direct effect (0.33) on the “motivation to self‐manage”, while “motivation to self‐manage” had an effect (−0.32) on the “ability to self‐manage”. The Goodness‐of‐Fit Index was 0.974. Conclusion “Body self‐awareness” plays a part in the self‐care operation process and serves as an intermediary factor to enable the performance of self‐care operations by making the most use of self‐care agency. Moreover, striking a proper balance between self‐management that is focused on the treatment of diabetes and a persons ability for self‐management of diabetes was found to be important.

Bayesian Regressions for Cross-Validation: An Application

It should be noticed that the traditional correlation analysis for investigating the validity of a psychological test is often insufficient because the correlation coefficient is usually obtained by maximizing the likelihood, which is derived from the given data set. Furthermore, a simple correlation makes no sense when the criterion variable is not completely the same among the several groups of subjects. In this paper, a Bayesian cross-validation using hierarchical regression model is considered. In order to investigate the predictive effectiveness of a test, the method of deriving the cross-validity index is considered. A practical application to the Numerical Reasoning Ability Test for Myanmar high school students is also shown, which contains the scores of school subject tests as the criterion variable. Then, it is found that the cross-validity index is useful because it indicates the predictive effectiveness of the NRT to the various school subject tests.