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Slivinski A, Kaiser J, Perry A, Bradford JY, Camarda A, Gilmore L, Horigan AE, MacPherson-Dias R, Slifko A, Van Dusen K, Bishop-Royse J, Delao AM. ENA Clinical Practice Guideline Synopsis: Suicide Risk Assessment. J Emerg Nurs 2024; 50:296-300. [PMID: 38453343 DOI: 10.1016/j.jen.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 09/06/2023] [Indexed: 03/09/2024]
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Mortality Following Nonfatal Opioid and Sedative/Hypnotic Drug Overdose. Am J Prev Med 2020; 59:59-67. [PMID: 32389530 PMCID: PMC7311279 DOI: 10.1016/j.amepre.2020.02.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 02/19/2020] [Accepted: 02/20/2020] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Opioid and sedative/hypnotic drug overdoses are major causes of morbidity in the U.S. This study compares 12-month incidence of fatal unintentional drug overdose, suicide, and other mortality among emergency department patients presenting with nonfatal opioid or sedative/hypnotic overdose. METHODS This is a retrospective cohort study using statewide, longitudinally linked emergency department patient record and mortality data from California. Participants comprised all residents presenting to a licensed emergency department at least once in 2009-2011 with nonfatal unintentional opioid overdose, sedative/hypnotic overdose, or neither (a 5% random sample). Participants were followed for 1 year after index emergency department presentation to assess death from unintentional overdose, suicide, or other causes, ascertained using ICD-10 codes. Absolute death rates per 100,000 person years and standardized mortality ratios relative to the general population were calculated. Data were analyzed February-August 2019. RESULTS Following the index emergency department visit, unintentional overdose death rates per 100,000 person years were 1,863 following opioid overdose, 342 following sedative/hypnotic overdose, and 31 for reference patients without an index overdose (respective standardized mortality ratios of 106.1, 95% CI=95.2, 116.9; 24.5, 95% CI=21.3, 27.6; and 2.6, 95% CI=2.2, 3.0). Suicide mortality rates per 100,000 were 319, 174, and 32 following opioid overdose, sedative/hypnotic overdose, and reference visits, respectively. Natural causes mortality rates per 100,000 were 8,058 (opioid overdose patients), 17,301 (sedative/hypnotic overdose patients), and 3,097 (reference patients). CONCLUSIONS Emergency department patients with nonfatal opioid or sedative/hypnotic drug overdose have exceptionally high risks of death from unintentional overdose, suicide, and other causes. Emergency department-based interventions offer potential for reducing these patients' overdose and other mortality risks.
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Zaleski ME, Johnson ML, Valdez AM, Bradford JY, Reeve NE, Horigan A, Killian M, Reeve NE, Slivinski A, Stapleton S, Vanhoy MA, Proehl J, Wolf L, Delao A, Gates L. Clinical Practice Guideline: Suicide Risk Assessment. J Emerg Nurs 2018; 44:505.e1-505.e33. [DOI: 10.1016/j.jen.2018.07.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Borschmann R, Young JT, Moran P, Spittal MJ, Snow K, Mok K, Kinner SA. Accuracy and predictive value of incarcerated adults' accounts of their self-harm histories: findings froman Australian prospective data linkage study. CMAJ Open 2017; 5:E694-E701. [PMID: 28893844 PMCID: PMC5621944 DOI: 10.9778/cmajo.20170058] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Self-harm is prevalent in prison populations and is a well-established risk factor for suicide. Researchers typically rely on self-report to measure self-harm, yet the accuracy and predictive value of self-report in prison populations is unclear. Using a large, representative sample of incarcerated men and women, we aimed to examine the level of agreement between self-reported self-harm history and historical medical records, and investigate the association between self-harm history and medically verified self-harm after release from prison. METHODS During confidential interviews with 1315 adults conducted within 6 weeks of expected release from 1 of 7 prisons in Queensland, Australia, participants were asked about the occurrence of lifetime self-harm. Responses were compared with prison medical records and linked both retrospectively and prospectively with ambulance, emergency department and hospital records to identify instances of medically verified self-harm. Follow-up interviews roughly 1, 3 and 6 months after release covered the same domains assessed in the baseline interview as well as self-reported criminal activity and contact with health care, social and criminal justice services since release. RESULTS Agreement between self-reported and medically verified history of self-harm was poor, with 64 (37.6%) of 170 participants with a history of medically verified self-harm disclosing a history of self-harm at baseline. Participants with a medically verified history of self-harm were more likely than other participants to self-harm during the follow-up period. Compared to the unconfirmed-negative group, the true-positive (adjusted hazard ratio [HR] 6.2 [95% confidence interval (CI) 3.3-10.4]), false-negative (adjusted HR 4.0 [95% CI 2.2-6.7]) and unconfirmed-positive (adjusted HR 2.2 [95% CI 1.2-3.9]) groups were at increased risk for self-harm after release from prison. INTERPRETATION Self-reported history of self-harm should not be considered a sensitive indicator of prior self-harm or of future self-harm risk in incarcerated adults. To identify those who should be targeted for preventive strategies, triangulation of data from multiple verifiable sources should be performed whenever possible.
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Affiliation(s)
- Rohan Borschmann
- Affiliations: Department of Psychiatry (Borschmann), The University of Melbourne, Melbourne;Centre for Adolescent Health (Borschmann, Kinner), Murdoch Childrens Research Institute, Parkville; Melbourne School of Population and Global Health (Borschmann, Young, Snow, Kinner), The University of Melbourne, Melbourne, Australia; Department of Health Service and Population Research (Borschmann), Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Centre for Health Services Research (Young), School of Population and Global Health, The University of Western Australia, Perth; National Drug Research Institute (Young), Curtin University, Perth, Australia; Centre for Academic Mental Health (Moran), University of Bristol, Bristol, UK; Centre for Mental Health (Spittal), Melbourne School of Population and Global Health, The University of Melbourne, Melbourne; Centre for International Child Health (Snow), Department of Paediatrics, The University of Melbourne, Melbourne; The Black Dog Institute (Mok), Randwick; Mater Research Institute (Kinner), The University of Queensland, South Brisbane; Griffith Criminology Institute (Kinner), Griffith University, Brisbane; School of Public Health and Preventive Medicine (Kinner), Monash University, Melbourne, Australia; Netherlands Institute for the Study of Crime and Law Enforcement (Kinner), Amsterdam, The Netherlands
| | - Jesse T Young
- Affiliations: Department of Psychiatry (Borschmann), The University of Melbourne, Melbourne;Centre for Adolescent Health (Borschmann, Kinner), Murdoch Childrens Research Institute, Parkville; Melbourne School of Population and Global Health (Borschmann, Young, Snow, Kinner), The University of Melbourne, Melbourne, Australia; Department of Health Service and Population Research (Borschmann), Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Centre for Health Services Research (Young), School of Population and Global Health, The University of Western Australia, Perth; National Drug Research Institute (Young), Curtin University, Perth, Australia; Centre for Academic Mental Health (Moran), University of Bristol, Bristol, UK; Centre for Mental Health (Spittal), Melbourne School of Population and Global Health, The University of Melbourne, Melbourne; Centre for International Child Health (Snow), Department of Paediatrics, The University of Melbourne, Melbourne; The Black Dog Institute (Mok), Randwick; Mater Research Institute (Kinner), The University of Queensland, South Brisbane; Griffith Criminology Institute (Kinner), Griffith University, Brisbane; School of Public Health and Preventive Medicine (Kinner), Monash University, Melbourne, Australia; Netherlands Institute for the Study of Crime and Law Enforcement (Kinner), Amsterdam, The Netherlands
| | - Paul Moran
- Affiliations: Department of Psychiatry (Borschmann), The University of Melbourne, Melbourne;Centre for Adolescent Health (Borschmann, Kinner), Murdoch Childrens Research Institute, Parkville; Melbourne School of Population and Global Health (Borschmann, Young, Snow, Kinner), The University of Melbourne, Melbourne, Australia; Department of Health Service and Population Research (Borschmann), Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Centre for Health Services Research (Young), School of Population and Global Health, The University of Western Australia, Perth; National Drug Research Institute (Young), Curtin University, Perth, Australia; Centre for Academic Mental Health (Moran), University of Bristol, Bristol, UK; Centre for Mental Health (Spittal), Melbourne School of Population and Global Health, The University of Melbourne, Melbourne; Centre for International Child Health (Snow), Department of Paediatrics, The University of Melbourne, Melbourne; The Black Dog Institute (Mok), Randwick; Mater Research Institute (Kinner), The University of Queensland, South Brisbane; Griffith Criminology Institute (Kinner), Griffith University, Brisbane; School of Public Health and Preventive Medicine (Kinner), Monash University, Melbourne, Australia; Netherlands Institute for the Study of Crime and Law Enforcement (Kinner), Amsterdam, The Netherlands
| | - Matthew J Spittal
- Affiliations: Department of Psychiatry (Borschmann), The University of Melbourne, Melbourne;Centre for Adolescent Health (Borschmann, Kinner), Murdoch Childrens Research Institute, Parkville; Melbourne School of Population and Global Health (Borschmann, Young, Snow, Kinner), The University of Melbourne, Melbourne, Australia; Department of Health Service and Population Research (Borschmann), Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Centre for Health Services Research (Young), School of Population and Global Health, The University of Western Australia, Perth; National Drug Research Institute (Young), Curtin University, Perth, Australia; Centre for Academic Mental Health (Moran), University of Bristol, Bristol, UK; Centre for Mental Health (Spittal), Melbourne School of Population and Global Health, The University of Melbourne, Melbourne; Centre for International Child Health (Snow), Department of Paediatrics, The University of Melbourne, Melbourne; The Black Dog Institute (Mok), Randwick; Mater Research Institute (Kinner), The University of Queensland, South Brisbane; Griffith Criminology Institute (Kinner), Griffith University, Brisbane; School of Public Health and Preventive Medicine (Kinner), Monash University, Melbourne, Australia; Netherlands Institute for the Study of Crime and Law Enforcement (Kinner), Amsterdam, The Netherlands
| | - Kathryn Snow
- Affiliations: Department of Psychiatry (Borschmann), The University of Melbourne, Melbourne;Centre for Adolescent Health (Borschmann, Kinner), Murdoch Childrens Research Institute, Parkville; Melbourne School of Population and Global Health (Borschmann, Young, Snow, Kinner), The University of Melbourne, Melbourne, Australia; Department of Health Service and Population Research (Borschmann), Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Centre for Health Services Research (Young), School of Population and Global Health, The University of Western Australia, Perth; National Drug Research Institute (Young), Curtin University, Perth, Australia; Centre for Academic Mental Health (Moran), University of Bristol, Bristol, UK; Centre for Mental Health (Spittal), Melbourne School of Population and Global Health, The University of Melbourne, Melbourne; Centre for International Child Health (Snow), Department of Paediatrics, The University of Melbourne, Melbourne; The Black Dog Institute (Mok), Randwick; Mater Research Institute (Kinner), The University of Queensland, South Brisbane; Griffith Criminology Institute (Kinner), Griffith University, Brisbane; School of Public Health and Preventive Medicine (Kinner), Monash University, Melbourne, Australia; Netherlands Institute for the Study of Crime and Law Enforcement (Kinner), Amsterdam, The Netherlands
| | - Katherine Mok
- Affiliations: Department of Psychiatry (Borschmann), The University of Melbourne, Melbourne;Centre for Adolescent Health (Borschmann, Kinner), Murdoch Childrens Research Institute, Parkville; Melbourne School of Population and Global Health (Borschmann, Young, Snow, Kinner), The University of Melbourne, Melbourne, Australia; Department of Health Service and Population Research (Borschmann), Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Centre for Health Services Research (Young), School of Population and Global Health, The University of Western Australia, Perth; National Drug Research Institute (Young), Curtin University, Perth, Australia; Centre for Academic Mental Health (Moran), University of Bristol, Bristol, UK; Centre for Mental Health (Spittal), Melbourne School of Population and Global Health, The University of Melbourne, Melbourne; Centre for International Child Health (Snow), Department of Paediatrics, The University of Melbourne, Melbourne; The Black Dog Institute (Mok), Randwick; Mater Research Institute (Kinner), The University of Queensland, South Brisbane; Griffith Criminology Institute (Kinner), Griffith University, Brisbane; School of Public Health and Preventive Medicine (Kinner), Monash University, Melbourne, Australia; Netherlands Institute for the Study of Crime and Law Enforcement (Kinner), Amsterdam, The Netherlands
| | - Stuart A Kinner
- Affiliations: Department of Psychiatry (Borschmann), The University of Melbourne, Melbourne;Centre for Adolescent Health (Borschmann, Kinner), Murdoch Childrens Research Institute, Parkville; Melbourne School of Population and Global Health (Borschmann, Young, Snow, Kinner), The University of Melbourne, Melbourne, Australia; Department of Health Service and Population Research (Borschmann), Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Centre for Health Services Research (Young), School of Population and Global Health, The University of Western Australia, Perth; National Drug Research Institute (Young), Curtin University, Perth, Australia; Centre for Academic Mental Health (Moran), University of Bristol, Bristol, UK; Centre for Mental Health (Spittal), Melbourne School of Population and Global Health, The University of Melbourne, Melbourne; Centre for International Child Health (Snow), Department of Paediatrics, The University of Melbourne, Melbourne; The Black Dog Institute (Mok), Randwick; Mater Research Institute (Kinner), The University of Queensland, South Brisbane; Griffith Criminology Institute (Kinner), Griffith University, Brisbane; School of Public Health and Preventive Medicine (Kinner), Monash University, Melbourne, Australia; Netherlands Institute for the Study of Crime and Law Enforcement (Kinner), Amsterdam, The Netherlands
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Runeson B, Odeberg J, Pettersson A, Edbom T, Jildevik Adamsson I, Waern M. Instruments for the assessment of suicide risk: A systematic review evaluating the certainty of the evidence. PLoS One 2017; 12:e0180292. [PMID: 28723978 PMCID: PMC5517300 DOI: 10.1371/journal.pone.0180292] [Citation(s) in RCA: 118] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 06/13/2017] [Indexed: 11/18/2022] Open
Abstract
Background Instruments have been developed to facilitate suicide risk assessment. We aimed to evaluate the evidence for these instruments including assessment of risk of bias and diagnostic accuracy for suicide and suicide attempt. Methods PubMed (NLM), PsycInfo, Embase, Cinahl and the Cochrane Library databases were searched until December 2014. We assessed risk of bias with QUADAS-2. The average sensitivity and specificity of each instrument was estimated and the certainty of the evidence was assessed with GRADE. We considered instruments with a sensitivity > 80% and a specificity > 50% to have sufficient diagnostic accuracy. Results Thirty-five relevant studies were identified but 14 were considered to have high risk of bias, leaving 21 studies evaluating altogether 15 risk assessment instruments. We could carry out meta-analyses for five instruments. For the outcome suicide attempt SAD PERSONS Scale had a sensitivity of 15% (95% CI 8–24) and specificity of 97% (96–98), and the Manchester Self-Harm Rule (MSHR) a sensitivity of 97% (97–97) and a specificity of 20% (20–21). ReACT, which is a modification of MSHR, had a similar low specificity, as did the Sodersjukhuset Self Harm Rule. For the outcome suicide, the Beck Hopelessness Scale had a sensitivity of 89% (78–95) and specificity of 42% (40–43). Conclusions Most suicide risk assessment instruments were supported by too few studies to allow for evaluation of accuracy. Among those that could be evaluated, none fulfilled requirements for sufficient diagnostic accuracy.
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Affiliation(s)
- Bo Runeson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Centre for Psychiatry Research, Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
- * E-mail:
| | - Jenny Odeberg
- Swedish Agency for Health Technology Assessment and Assessment of Social Services, Stockholm, Sweden
| | - Agneta Pettersson
- Swedish Agency for Health Technology Assessment and Assessment of Social Services, Stockholm, Sweden
| | - Tobias Edbom
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | | | - Margda Waern
- Department of Psychiatry and Neurochemistry, University of Göteborg, Göteborg, Sweden
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Carter G, Milner A, McGill K, Pirkis J, Kapur N, Spittal MJ. Predicting suicidal behaviours using clinical instruments: systematic review and meta-analysis of positive predictive values for risk scales. Br J Psychiatry 2017; 210:387-395. [PMID: 28302700 DOI: 10.1192/bjp.bp.116.182717] [Citation(s) in RCA: 208] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Revised: 10/16/2016] [Accepted: 11/16/2016] [Indexed: 01/17/2023]
Abstract
BackgroundPrediction of suicidal behaviour is an aspirational goal for clinicians and policy makers; with patients classified as 'high risk' to be preferentially allocated treatment. Clinical usefulness requires an adequate positive predictive value (PPV).AimsTo identify studies of predictive instruments and to calculate PPV estimates for suicidal behaviours.MethodA systematic review identified studies of predictive instruments. A series of meta-analyses produced pooled estimates of PPV for suicidal behaviours.ResultsFor all scales combined, the pooled PPVs were: suicide 5.5% (95% CI 3.9-7.9%), self-harm 26.3% (95% CI 21.8-31.3%) and self-harm plus suicide 35.9% (95% CI 25.8-47.4%). Subanalyses on self-harm found pooled PPVs of 16.1% (95% CI 11.3-22.3%) for high-quality studies, 32.5% (95% CI 26.1-39.6%) for hospital-treated self-harm and 26.8% (95% CI 19.5-35.6%) for psychiatric in-patients.ConclusionsNo 'high-risk' classification was clinically useful. Prevalence imposes a ceiling on PPV. Treatment should reduce exposure to modifiable risk factors and offer effective interventions for selected subpopulations and unselected clinical populations.
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Affiliation(s)
- Gregory Carter
- Gregory Carter, MBBS, Cert Child Psych, PhD, FRANZCP, Centre for Brain and Mental Health Research, University of Newcastle, New South Wales, Australia; Allison Milner, BJPsych (Hons), MEpi, PhD, Population Health Strategic Research Centre, Deakin University, Burwood, and Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia; Katie McGill, MPsych (Clin), DClinPsych, Centre for Brain and Mental Health Research, University of Newcastle, New South Wales, Australia; Jane Pirkis, MPsych, MAppEpid, PhD, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia; Nav Kapur, MBChB, MMedSci, MD, FRCPsych, Centre for Suicide Prevention, Manchester Academic Health Science Centre, University of Manchester, and Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK; Matthew J. Spittal, MBiostat, PhD, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Allison Milner
- Gregory Carter, MBBS, Cert Child Psych, PhD, FRANZCP, Centre for Brain and Mental Health Research, University of Newcastle, New South Wales, Australia; Allison Milner, BJPsych (Hons), MEpi, PhD, Population Health Strategic Research Centre, Deakin University, Burwood, and Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia; Katie McGill, MPsych (Clin), DClinPsych, Centre for Brain and Mental Health Research, University of Newcastle, New South Wales, Australia; Jane Pirkis, MPsych, MAppEpid, PhD, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia; Nav Kapur, MBChB, MMedSci, MD, FRCPsych, Centre for Suicide Prevention, Manchester Academic Health Science Centre, University of Manchester, and Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK; Matthew J. Spittal, MBiostat, PhD, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Katie McGill
- Gregory Carter, MBBS, Cert Child Psych, PhD, FRANZCP, Centre for Brain and Mental Health Research, University of Newcastle, New South Wales, Australia; Allison Milner, BJPsych (Hons), MEpi, PhD, Population Health Strategic Research Centre, Deakin University, Burwood, and Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia; Katie McGill, MPsych (Clin), DClinPsych, Centre for Brain and Mental Health Research, University of Newcastle, New South Wales, Australia; Jane Pirkis, MPsych, MAppEpid, PhD, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia; Nav Kapur, MBChB, MMedSci, MD, FRCPsych, Centre for Suicide Prevention, Manchester Academic Health Science Centre, University of Manchester, and Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK; Matthew J. Spittal, MBiostat, PhD, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Jane Pirkis
- Gregory Carter, MBBS, Cert Child Psych, PhD, FRANZCP, Centre for Brain and Mental Health Research, University of Newcastle, New South Wales, Australia; Allison Milner, BJPsych (Hons), MEpi, PhD, Population Health Strategic Research Centre, Deakin University, Burwood, and Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia; Katie McGill, MPsych (Clin), DClinPsych, Centre for Brain and Mental Health Research, University of Newcastle, New South Wales, Australia; Jane Pirkis, MPsych, MAppEpid, PhD, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia; Nav Kapur, MBChB, MMedSci, MD, FRCPsych, Centre for Suicide Prevention, Manchester Academic Health Science Centre, University of Manchester, and Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK; Matthew J. Spittal, MBiostat, PhD, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Nav Kapur
- Gregory Carter, MBBS, Cert Child Psych, PhD, FRANZCP, Centre for Brain and Mental Health Research, University of Newcastle, New South Wales, Australia; Allison Milner, BJPsych (Hons), MEpi, PhD, Population Health Strategic Research Centre, Deakin University, Burwood, and Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia; Katie McGill, MPsych (Clin), DClinPsych, Centre for Brain and Mental Health Research, University of Newcastle, New South Wales, Australia; Jane Pirkis, MPsych, MAppEpid, PhD, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia; Nav Kapur, MBChB, MMedSci, MD, FRCPsych, Centre for Suicide Prevention, Manchester Academic Health Science Centre, University of Manchester, and Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK; Matthew J. Spittal, MBiostat, PhD, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Matthew J Spittal
- Gregory Carter, MBBS, Cert Child Psych, PhD, FRANZCP, Centre for Brain and Mental Health Research, University of Newcastle, New South Wales, Australia; Allison Milner, BJPsych (Hons), MEpi, PhD, Population Health Strategic Research Centre, Deakin University, Burwood, and Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia; Katie McGill, MPsych (Clin), DClinPsych, Centre for Brain and Mental Health Research, University of Newcastle, New South Wales, Australia; Jane Pirkis, MPsych, MAppEpid, PhD, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia; Nav Kapur, MBChB, MMedSci, MD, FRCPsych, Centre for Suicide Prevention, Manchester Academic Health Science Centre, University of Manchester, and Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK; Matthew J. Spittal, MBiostat, PhD, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
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Li G, Thabane L, Delate T, Witt DM, Levine MAH, Cheng J, Holbrook A. Can We Predict Individual Combined Benefit and Harm of Therapy? Warfarin Therapy for Atrial Fibrillation as a Test Case. PLoS One 2016; 11:e0160713. [PMID: 27513986 PMCID: PMC4981352 DOI: 10.1371/journal.pone.0160713] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 07/22/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES To construct and validate a prediction model for individual combined benefit and harm outcomes (stroke with no major bleeding, major bleeding with no stroke, neither event, or both) in patients with atrial fibrillation (AF) with and without warfarin therapy. METHODS Using the Kaiser Permanente Colorado databases, we included patients newly diagnosed with AF between January 1, 2005 and December 31, 2012 for model construction and validation. The primary outcome was a prediction model of composite of stroke or major bleeding using polytomous logistic regression (PLR) modelling. The secondary outcome was a prediction model of all-cause mortality using the Cox regression modelling. RESULTS We included 9074 patients with 4537 and 4537 warfarin users and non-users, respectively. In the derivation cohort (n = 4632), there were 136 strokes (2.94%), 280 major bleedings (6.04%) and 1194 deaths (25.78%) occurred. In the prediction models, warfarin use was not significantly associated with risk of stroke, but increased the risk of major bleeding and decreased the risk of death. Both the PLR and Cox models were robust, internally and externally validated, and with acceptable model performances. CONCLUSIONS In this study, we introduce a new methodology for predicting individual combined benefit and harm outcomes associated with warfarin therapy for patients with AF. Should this approach be validated in other patient populations, it has potential advantages over existing risk stratification approaches as a patient-physician aid for shared decision-making.
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Affiliation(s)
- Guowei Li
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON, Canada
- St. Joseph's Hospital, McMaster University, Hamilton, ON, Canada
| | - Lehana Thabane
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON, Canada
- St. Joseph's Hospital, McMaster University, Hamilton, ON, Canada
- * E-mail: (AH); (LT)
| | - Thomas Delate
- Kaiser Permanente Colorado Clinical Pharmacy Research Team, Aurora, CO, United States of America
- University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Denver, CO, United States of America
| | - Daniel M. Witt
- Department of Pharmacotherapy, University of Utah, Salt Lake City, Utah, United States of America
| | - Mitchell A. H. Levine
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON, Canada
- St. Joseph's Hospital, McMaster University, Hamilton, ON, Canada
- Division of Clinical Pharmacology & Toxicology, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Ji Cheng
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON, Canada
- St. Joseph's Hospital, McMaster University, Hamilton, ON, Canada
| | - Anne Holbrook
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON, Canada
- St. Joseph's Hospital, McMaster University, Hamilton, ON, Canada
- Division of Clinical Pharmacology & Toxicology, Department of Medicine, McMaster University, Hamilton, ON, Canada
- * E-mail: (AH); (LT)
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Stefansson J, Nordström P, Runeson B, Åsberg M, Jokinen J. Combining the Suicide Intent Scale and the Karolinska Interpersonal Violence Scale in suicide risk assessments. BMC Psychiatry 2015; 15:226. [PMID: 26400812 PMCID: PMC4581451 DOI: 10.1186/s12888-015-0607-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 09/10/2015] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND High suicide intent, childhood trauma, and violent behavior are risk factors for suicide in suicide attempters. The aim of this study was to investigate whether the combined assessment of suicide intent and interpersonal violence would provide a better prediction of suicide risk than an assessment of only suicide intent or interpersonal violence. METHODS This is a cohort study involving 81 suicide attempters included in the study between 1993 and 1998. Patients were assessed with both the Suicide Intent Scale (SIS) and the Karolinska Interpersonal Violence Scale (KIVS). Through the unique personal identification number in Sweden, patients were linked to the Cause of Death Register maintained by the Swedish National Board of Health and Welfare. Suicides were ascertained from the death certificates. RESULTS Seven of 14 patients who had died before April 2013 had committed suicide. The positive predictive value for the Suicide Intent Scale alone was 16.7 %, with a specificity of 52 % and an area under the curve of 0.74. A combined assessment with the KIVS gave higher specificity (63 %) and a positive predictive value of 18.8 % with an AUC of 0.83. Combined use of SIS and KIVS expressed interpersonal violence as an adult subscale gave a sensitivity of 83.3 %, a specificity of 80.3 %, and a positive predictive value of 26 % with an AUC of 0.85. The correlation between KIVS and SIS scores was not significant. CONCLUSIONS Using both the the SIS and the KIVS combined may be better for predicting completed suicide than using them separately. The nonsignificant correlation between the scales indicates that they measure different components of suicide risk.
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Affiliation(s)
- J. Stefansson
- Department of Clinical Neuroscience, Psychiatry Section, Karolinska Institutet, Karolinska University Hospital, Building R5, Solna, SE-171 76 Stockholm Sweden
| | - P. Nordström
- Department of Clinical Neuroscience, Psychiatry Section, Karolinska Institutet, Karolinska University Hospital, Building R5, Solna, SE-171 76 Stockholm Sweden
| | - B. Runeson
- Department of Clinical Neuroscience, Psychiatry Section, Karolinska Institutet, Karolinska University Hospital, Building R5, Solna, SE-171 76 Stockholm Sweden
| | - M. Åsberg
- Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden
| | - J. Jokinen
- Department of Clinical Neuroscience, Psychiatry Section, Karolinska Institutet, Karolinska University Hospital, Building R5, Solna, SE-171 76 Stockholm Sweden ,Department of Clinical Sciences, Umeå University, Umeå, Sweden
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Bilén K, Pettersson H, Owe-Larsson B, Ekdahl K, Ottosson C, Castrén M, Ponzer S. Can early follow-up after deliberate self-harm reduce repetition? A prospective study of 325 patients. J Affect Disord 2014; 152-154:320-5. [PMID: 24148790 DOI: 10.1016/j.jad.2013.09.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Revised: 09/15/2013] [Accepted: 09/16/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Patients who deliberately harm themselves often repeat their self-destructive acts. The objective of this study was to assess whether a follow-up visit within 10 days to a psychiatric consultant could reduce the frequency of repeated deliberate self-harm (DSH). METHODS A cohort of 325 consecutive DSH patients attending two large emergency departments in Stockholm, Sweden, were included and followed for 6 months. Any visit to a psychiatric consultant within 10 days was registered as an early follow-up. Repeated DSH episode within 6 months among the 325 patients was detected via nationwide registers. MAIN OUTCOME MEASURE Repeated DSH within 6 months. RESULTS At 6 months follow-up 22 (24%) of 92 patients with an early follow-up had repeated their DSH acts compared to 58 (25%) of 233 patients without an early follow-up (OR 1.06 (95% CI: 0.60-1.85) p-value 0.85). After adjustment for possible confounders, multivariable analysis showed an OR of 1.22 (95% CI: 0.62-2.38, p-value 0.56). LIMITATIONS Early follow-up was registered as any visit to a psychiatric consultant and no information regarding actions taken at the visit were obtained. CONCLUSION After adjusting for other factors associated with repetition there was an association of patients who were offered and thereafter attended an early follow-up visit and a decreased risk of repeated DSH.
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Affiliation(s)
- Katarina Bilén
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden; Section of Internal Medicine, Södersjukhuset, SE-118 83 Stockholm, Sweden; Section of Emergency Medicine, Sweden.
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Can repetition of deliberate self-harm be predicted? A prospective multicenter study validating clinical decision rules. J Affect Disord 2013; 149:253-8. [PMID: 23453675 DOI: 10.1016/j.jad.2013.01.037] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Revised: 01/23/2013] [Accepted: 01/25/2013] [Indexed: 11/22/2022]
Abstract
BACKGROUND Clinical decision rules have been developed to help identify patients at high risk of repeating deliberate self-harm actions. The objective of this study was to prospectively validate the clinical decision rules', Södersjukhuset Self-Harm Rule and Manchester Self-Harm Rule, ability to predict repetition of deliberate self-harm (DSH). METHODS A consecutive series of 325 patients attending two large emergency departments in Stockholm, Sweden due to DSH were included and followed for six months. Predictive factors were collected from hospital charts at the emergency department. A nationwide register-based follow-up of new DSH within six months was used. We calculated the sensitivity and specificity to evaluate the different decision rules' ability to identify repetition of DSH. Main outcome measure repeated DSH within six months. RESULTS The cumulative incidence for patients repeating within six months was 24.6% (95% CI: 19.9-29.3). Application of Södersjukhuset Self-Harm Rule yielded a sensitivity of 89% (95%CI: 79.2-94.4) and a specificity of 11% (95%CI: 7.9-16.2). Application of Manchester Self-Harm Rule to our material yielded a sensitivity of 94% (95%CI: 85.4-97.7) and a specificity of 18% (95%CI: 13.8-23.9). LIMITATIONS If data regarding predictive factors were missing it was not possible to investigate this further and in the statistical analysis missing data was classified as no. This would imply that the predicted risks may be underestimated. CONCLUSION Clinical decision rules could be used as a compliment providing important additional information regarding risk of repetition in an ED setting when focusing on high sensitivity.
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