Suicidal behavior on Axis VI: clinical data supporting a sixth Axis for DSM-V.
Suicidal behavior on Axis VI: clinical data supporting a sixth Axis for DSM-V.
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VI 轴上的自杀行为：支持 DSM-V 第六轴的临床数据。
DOI：
10.1027/0227-5910/a000057
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发表时间：
2011
期刊：
影响因子：
3
通讯作者：
JoinerJr,ThomasE
中科院分区：
文献类型：
--
作者：
VanOrden,KimberlyA;Witte,TracyK;Holm-Denoma,Jill;Gordon,KathrynH;JoinerJr,ThomasE
Background. Oquendo and colleagues (Oquendo, Baca-García, Mann, & Giner, 2008; Oquendo & Currier, 2009) recommend that DSM-V emphasize suicide risk assessment on a sixth axis, thereby increasing regularity of suicide risk assessments. Aims. We propose that evidence of nonredundancy with Axis V–Global Assessment of Functioning (GAF) is one piece of data that can serve as a starting point for a line of research establishing incremental predictive utility for a separate suicide risk assessment in the DSM framework. Methods. A standardized suicide risk assessment protocol, measures of depressive, anxious, and eating disordered symptomatology, as well as an index of comorbidity were administered to a sample of 412 adult outpatients. Results. Our data indicate that data from standardized suicide risk assessments are associated with indices of symptomatology severity as well as comorbidity, controlling for GAF. Conclusions. These results support the nonredundancy of the assessments and suggest the utility of longitudinal investigations of the predictive utility of a sixth DSM axis in the assessment of suicide risk.BackgroundOquendo and colleagues (Oquendo, Baca-García, Mann, & Giner, 2008; Oquendo & Currier, 2009) recommend that DSM-V emphasize suicide risk assessment on a sixth axis, thereby increasing the regularity of suicide risk assessments. In addition, Kennedy and colleagues (Kennedy, 1992) also recommend separating assessment of risk for suicide and violence into a separate axis (Higgins & Purvis, 2000). Currently, Axis V–Global Assessment of Functioning (GAF)–advises clinicians to incorporate suicidality into overall ratings of functioning. Thus it is possible that the current five axial system–specifically GAF–adequately measures and documents suicide risk.AimsWe examined whether information gathered from systematic suicide risk assessment provides incremental information about treatment-relevant variables above and beyond information gathered from GAF scores. We predicted that greater suicide risk would be associated with greater symptom severity as well as greater comorbidity. Further–and central to our study aims–we predicted that these associations would persist while controlling for GAF scores. Support for the latter result would support our claim that information about patient functioning gathered through suicide risk assessments is not reducible to information gathered through GAF assessments. We propose that evidence of nonredundancy with GAF can serve as a starting point for establishing the incremental predictive utility of a separate suicide risk assessment in the DSM framework. Multiaxial assessment procedures that include ratings of disability and functioning have been proposed for other classification systems outside of the United States, including for the ICD-10 (Dittmann & Dilling, 1990; Michels et al., 1996), indicating a potentially broader range of applicability for this investigation.MethodsParticipantsThe sample included 412 adult outpatients (41% male) from the Florida State University Psychology Clinic admitted from 2004 to 2008. The clinic is an outpatient community mental health center that does not serve as the University’s student counseling center and employs minimal exclusionary criteria, excluding from treatment only persons with psychotic or bipolar-spectrum disorders who do not take actions to become stabilized on medications, and individuals in need of a higher level of care than can be provided on an outpatient basis. Ages ranged from 18 to 65 years old (M= 26, SD= 9.20). The racial/ethnic composition was 76% White, 9% Hispanic, 10% Black/African-American, 3% Asian …
