Honesty in reporting suicidal ideations and behaviors in Alzheimer’s disease, mild cognitive impairment, and dementias
Background: Detection of patients’ suicidal ideations and behaviors (SIB) is critical to patient safety. It is important to consider the needs, abilities and propensity for honesty in reporting SIB in populations with compromised cognitive abilities. We surveyed patients with compromised cognitive abilities to determine if they feel they would report SIB and the conditions under which they would be honest in reporting SIB?
Methods: Patients reporting diagnoses such as Alzheimer’s disease (AD), mild cognitive impairment (MCI) or other dementias completed online surveys. Participants were asked their likelihood for honesty, preferences and comfort when answering questions on SIB in-person and using electronic self-report.
Results: 73 patients with AD, MCI or other dementias, 95% reported they were likely to report SIB honestly electronically and 92% would be honest with a health care provider (HCP). However, 96% would be honest in-person with an HCP they knew but less than 88% said they would be honest if they didn’t know the HCP.
Conclusions: These data suggest that patients with cognitive conditions may be more likely to report SIB truthfully using electronic self-report than a clinical face to face interview but that either form of reporting is an effective methodology for obtaining honest responses about SIB. Taking the FDA guidance on suicidality and the potential for cognitive decrements in this population, multiple tools for assessing depression and SIB should be implemented when treating or working this population.
Serafini G, Calcagno P, Lester D, Girardi P, Amore M, Pompili M. Suicide Risk in Alzheimer's Disease: A Systematic Review. Curr Alzheimer Res. 2016;13:1083-99.
CDC. Alzheimer's Disease, 2015. Available at https://www.cdc.gov/aging/aginginfo/alzheimers.htm.
Alzheimer's Association. Alzheimer’s Disease Facts and Figures. Alzheimer's & Dementia 2017;13:325-73.
National Institute of Mental Health. Chronic illness and Mental Health: recognizing and treating depression. In: U.S. Department of Health and Human Services (Edition). Bethesda: MD; 2017.
Gruber-Baldini AL, Zimmerman S, Boustani M, Watson LC, Williams CS, Reed PS. Characteristics associated with depression in long-term care residents with dementia. Gerontologist 2005;45(Spec No 1):50-5.
Usman S, Chaudhary HR, Asif A, Yahya MI. Severity and risk factors of depression in Alzheimer's disease. J Coll Physicians Surg Pak. 2010;20:327-30.
Yamamoto RT, Durand EM, Khurana L, Tuller J, Yershova K, Dallabrida S. Patients with psychiatric diagnoses indicate willingness to report suicideal ideation and behavior more honestly by self-report than in face-to-face interviews. CNS Summit. Boca Raton, Florida; 2016.
FDA. Guidance for Industry, Suicidal Ideation and Behavior: Prospective Assessment of Occurance in Clinical Trials. In: Services USDoHaH (Edition). Silver Spring: MD; 2012.
Ratcliffe SL, Chappell PB, Boyce-Rustay J, Gloukhova S, Oleske DM. Treatment Emergent Suicidal Ideation and Behavior. In: Cannon KE and Hudzik TJ (eds). Suicide: Phenomenology and Neurobiology. New York: Springer International Publishing; 2014: 31-58.
Luoma JB, Martin CE and Pearson JL. Contact with mental health and primary care providers before suicide: a review of the evidence. Am J Psychiatry. 2002;159:909-16.
Feldman MD, Franks P, Duberstein PR, Vannoy S, Epstein R, Kravitz RL. Let's not talk about it: suicide inquiry in primary care. Ann Fam Med. 2007;5:412-8.
Stoppe G, Sandholzer H, Huppertz C, Hauke D, Juergen S. Family physicians and the risk of suicide in the depressed elderly. Journal of Affective Disorders. 1999;54:193-8.
Haw C, Harwood D and Hawton K. Dementia and suicidal behavior: a review of the literature. Int Psychogeriatr 2009;21:440-53.
Durand EM, Yamamoto RT, Lima V. The electronic self-report of the C-SSRS (eC-SSRS) shows sensitve and reliable performance, reducing burden on subjects & sites. ISCTM. Philadelphia, PA; 2016.