Evaluating chronic suicide risk with the Personality Assessment Inventory: Development and initial validation of the Chronic Suicide Risk Index (S_Chron)

Using the Personality Assessment Inventory to Assess the Alternative Model for Personality Disorders: Criterion Validity in a Clinical Sample

The Personality Assessment Inventory (PAI) is a broadband measure of psychopathology that is widely used in applied settings. Researchers developed regression-based estimates that use the PAI to measure constructs of the Alternative Model for Personality Disorders (AMPD) - a hybrid dimensional and categorical approach to conceptualizing personality disorders. Although prior work has linked these estimates to formal measures of the AMPD, there is little work investigating the clinical correlates of this scoring approach of the PAI. The current study examines associations between these PAI-based AMPD estimates and life data in a large, archival dataset of psychiatric outpatients and inpatients. We found general support for the criterion validity of AMPD estimate scores, such that a theoretically consistent pattern of associations emerged with indicators such as prior academic achievement, antisocial behavior, psychiatric history, and substance abuse. These results provide preliminary support to this scoring approach for use in clinical samples.

Characteristics of Single vs. Multiple Suicide Attempters Among Adult Population: A Systematic Review and Meta-Analysis

PURPOSE OF REVIEW

We aimed to examine the factors that differentiate single and multiple suicide attempters in adult population. We followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines to conduct this review and meta-analysis. The review protocol was registered in PROSPERO. We carried out a systematic literature search in three databases to identify original studies that explored the differences between single and multiple suicide attempters among adult population.

RECENT FINDINGS

There might be meaningful differences between those individuals that attempt suicide once in their lifespan and those who make multiple attempts in terms of sociodemographic and clinical characteristics. There are no previous meta-analysis addressing this topic in the adult population. A total of 75 studies were included in the review and 69 were included in the meta-analysis. Multiple attempters were more likely to present certain disorders such as mood and psychotic disorders, as well as personality or substance use disorders. Higher suicide ideation and suicide intent scores also characterized this group. Childhood trauma experiences, stressful life events, and higher rates of hopelessness were statistically significant in multiple attempters. Identifying the factors predicting multiple suicide attempts helps to delineate a high-risk suicidal profile that should be taken into account in the clinical and suicide prevention scenario.

Personality assessment inventory items in relation to patient- and therapist-rated alliance

Based on the results of prior research, we examined relationships between Personality Assessment Inventory (PAI) items on clinical scales of antisocial features (ANT) and anxiety-related disorders (ARD) with patient- and therapist-rated alliance early in treatment (third or fourth session). We also explored the relationship between the PAI treatment rejection scale (RXR) and early session therapist-rated alliance, despite null findings in previous work. We used PAI protocols from a clinical outpatient sample (N = 80). Data were analysed using backwards linear regressions. Results indicated that a group of ANT items from different ANT subscales predicted patient-rated therapeutic alliance, F(8,59) = 5.182, p = .000, R² of .413, f²  = 0.70. Additionally, a group of ARD items from different ARD subscales significantly predicted therapist-rated alliance, F(6,62) = 3.007, p = .012, R² of .225, f²  = 0.29. No significant relationships were found for RXR items and therapist-rated alliance, consistent with prior findings. Clinical implications are discussed.

Classification of Adolescent Psychiatric Patients at High Risk of Suicide Using the Personality Assessment Inventory by Machine Learning

OBJECTIVE

There are growing interests on suicide risk screening in clinical settings and classifying high-risk groups of suicide with suicidal ideation is crucial for a more effective suicide preventive intervention. Previous statistical techniques were limited because they tried to predict suicide risk using a simple algorithm. Machine learning differs from the traditional statistical techniques in that it generates the most optimal algorithm from various predictors.

METHODS

We aim to analyze the Personality Assessment Inventory (PAI) profiles of child and adolescent patients who received outpatient psychiatric care using machine learning techniques, such as logistic regression (LR), random forest (RF), artificial neural network (ANN), support vector machine (SVM), and extreme gradient boosting (XGB), to develop and validate a classification model for individuals with high suicide risk.

RESULTS

We developed prediction models using seven relevant features calculated by Boruta algorithm and subsequently tested all models using the testing dataset. The area under the ROC curve of these models were above 0.9 and the RF model exhibited the best performance.

CONCLUSION

Suicide must be assessed based on multiple aspects, and although Personality Assessment Inventory for Adolescent assess an array of domains, further research is needed for predicting high suicide risk groups.

Suicide risk of male State patients with antisocial personality traits

Background

Suicide mortality rates are higher in people with personality disorders, especially those who have antisocial personality traits. These mortality rates are also higher in people who have committed offences. Antisocial personality traits are very common in populations who have committed offences and in forensic psychiatric patients.

Aim

To determine if male State patients with antisocial personality traits had a higher risk of suicide compared with patients with no antisocial personality traits. We tried to identify other risk factors for attempted suicide in this population.

Setting

Weskoppies Hospital’s Forensic Unit, Pretoria, South Africa.

Methods

Of the 275 male State patients, 37 had antisocial personality traits and were included in the study. Of the remaining State patients, we randomly selected 37 control group participants, who had no antisocial personality traits. For each participant, we completed a data capturing sheet and a Beck’s Suicide Ideation Scale (BSIS). We compared suicide risk and associated factors between study and control group participants.

Results

Study group and control group participants had the same current suicide risk. Overall, 63 participants (85.14%) had no current suicide risk. Of the 11 (14.86%) remaining participants with current suicide risk, 5 had antisocial personality traits. Eighteen had previous suicide attempts, 13 of whom had antisocial personality traits.

Conclusion

State patients with and without antisocial personality traits had similar current suicide risk. Although antisocial personality disorder is an identified risk factor for suicide, it was not the case in this study. Assessment of other risk factors for suicide should be prioritised.

Cross-validation of the Personality Assessment Inventory "Chronic Suicide Risk Index: S_Chron" in a large sample of offenders

Recently, Sinclair et al. (2016) reported on the development of a new Personality Assessment Inventory (PAI) index designed to identify individuals with histories of multiple suicide attempts (Chronic Suicide Risk Index: S_Chron). We evaluated this new index in a sample of over 1000 criminal offenders who had been administered the PAI as part of a more extensive research project. The S_Chron meaningfully discriminated between those with multiple prior suicide attempts and those with 0-1 attempts, similar to what Sinclair et al. reported. However, it did not demonstrate incremental validity beyond the PAI's Suicidal Ideation scale.