ORIGINAL RESEARCH article
Front. Psychiatry
Sec. Mood Disorders
Identifying Subtypes of Suicidality: A Second Larger Consensus Study in Emergency Clinical Psychiatric Practice
Provisionally accepted
Remco F.P. de Winter1,2*
Damien S.E. Broekharst1,2Connie M. Meijer3Anne T. van den Bos3Nienke Kool3John H. Enterman3Manuela Gemen1Chani Nuij4Mirjam C. Hazewinkel3Danielle Steentjes1Gabrielle van Son1
Jonas Weijers1,2Derek de Beurs5Marieke H. de Groot6- 1GGZ Rivierduinen, Leiden, Netherlands
- 2Universiteit Maastricht School for Mental Health and Neuroscience, Maastricht, Netherlands
- 3Parnassia Academie, The Hague, Netherlands
- 4Universiteit Twente, Enschede, Netherlands
- 5Universiteit van Amsterdam, Amsterdam, Netherlands
- 6Stichting Lentis Maatschappelijke Onderneming, Zuidlaren, Netherlands
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Background: A model has been developed to distinguish subtypes of pathways to entrapment leading to suicidality in clinical mental health practice. The (hypothetical) 4-type Model of Entrapment ((h)4ME) delineates four subtypes of suicidality: I) Perceptual Disintegration (PD), II) Primary Depressive Cognition (PDC), III) Psychosocial Turmoil (PT) and IV) Inadequate Coping/Communication (IC). Objective To examine the model's usability and feasibility in a larger cohort of suicidal patients (n= 75) following a pilot study. Methods: Consultation reports to general practitioners of 75 suicidal emergency patients were independently allocated to subtypes by three psychiatrists and three nurses using the SUICIDI-3 tool. This tool describes the proposed subtypes. Interrater agreement was assessed by calculating Intraclass Correlation Coefficients (ICCs). Absolute and dimensional type agreement was established to assess the model's usability and the SUICIDI-3 tools feasibility. Results: All raters were able to assign cases to subtypes. Excellent absolute Type Agreement (aTA) was observed for PD (0.96) and PDC (0.92), and good aTA for PT (0.83) and IC (0.83). For dimensional Type Agreement (dTA) the ICC was excellent for PD (0.97), PDC (0.95) and IC 0.92), and good for PT (0.88). Conclusions The (h)4ME demonstrates promising usability and feasibility when tested by staff of psychiatric emergency services. Replication studies of samples of various clinical, demographic or ethnic origin and of diverse professional background and contexts are needed to confirm the consistency of these findings.
Keywords: differentiation of suicidality, feasibility, suicidal subtypes, suicidal typology, Suicidality, SUICIDI, tailored assessment, usability
Received: 21 Nov 2025; Accepted: 12 Feb 2026.
Copyright: © 2026 de Winter, Broekharst, Meijer, van den Bos, Kool, Enterman, Gemen, Nuij, Hazewinkel, Steentjes, van Son, Weijers, de Beurs and de Groot. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Remco F.P. de Winter
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