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Riblet NB, Matsunaga S, Shiner B, Schnurr PP, Watts BV. Are suicide risk scales sensitive to change? A scoping review. J Psychiatr Res 2023; 161:170-178. [PMID: 36931135 PMCID: PMC10149613 DOI: 10.1016/j.jpsychires.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 02/24/2023] [Accepted: 03/02/2023] [Indexed: 03/19/2023]
Abstract
INTRODUCTION Clinician- or self-administered scales are frequently used to assist in detecting risk of death by suicide and to determine the effectiveness of interventions. No recent review studies have examined whether these scales are sensitive to change. We conducted a scoping review to identify suicide risk scales that are sensitive to change. MATERIAL AND METHODS We searched Medline and Excerpta Medica Database from inception through March 17, 2022, to identify randomized trials, pooled analysis, quasi-experimental studies, and cohort studies reporting on sensitivity to change of suicide risk scales. We assessed sensitivity to change by examining internal and external responsiveness. Internal responsiveness evaluates whether the scale measures changes in suicide-related symptoms in response to an intervention while external responsiveness assess whether changes in the scale correspond to changes in risk of suicide. We summarized findings across studies using descriptive analysis. RESULTS Among 38 eligible scales, we identified 27 scales that included items that were modifiable to change. However, only 7 scales had been studied to determine their sensitivity to change based on internal or external responsiveness. While the results of studies suggested that 6 scales have internal responsiveness, none of the included studies confirmed that scales have external responsiveness. DISCUSSION A few suicide risk scales are internally responsive and may be useful in a clinical or research setting. It is unclear, however, whether changes in scores correspond to an actual change in suicide risk. Future research should confirm the external responsiveness of scales using robust metrics including suicide mortality.
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Affiliation(s)
- Natalie B Riblet
- Veterans Affairs Medical Center, Mental Health Service, 215 North Main Street, White River Junction, VT, 05009, USA; Geisel School of Medicine at Dartmouth College, 1 Rope Ferry Road, Hanover NH, 03755, USA.
| | - Sarah Matsunaga
- Geisel School of Medicine at Dartmouth College, 1 Rope Ferry Road, Hanover NH, 03755, USA
| | - Brian Shiner
- Veterans Affairs Medical Center, Mental Health Service, 215 North Main Street, White River Junction, VT, 05009, USA; Geisel School of Medicine at Dartmouth College, 1 Rope Ferry Road, Hanover NH, 03755, USA; National Center for PTSD, 215 North Main Street, White River Junction, VT, 05009, USA
| | - Paula P Schnurr
- Geisel School of Medicine at Dartmouth College, 1 Rope Ferry Road, Hanover NH, 03755, USA; National Center for PTSD, 215 North Main Street, White River Junction, VT, 05009, USA
| | - Bradley V Watts
- Veterans Affairs Medical Center, Mental Health Service, 215 North Main Street, White River Junction, VT, 05009, USA; Geisel School of Medicine at Dartmouth College, 1 Rope Ferry Road, Hanover NH, 03755, USA; Veterans Rural Health Resource Center, White River Junction VA Medical Center, White River Junction, VT, 05009, USA
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Sher L, Challman KN, Smith EC, New AS, Perez-Rodriguez MM, McClure MM, Goodman M, Kahn RS, Hazlett EA. Clinical features of individuals with schizotypal personality disorder with and without suicidal ideation. Psychiatry Res 2023; 322:115132. [PMID: 36841053 DOI: 10.1016/j.psychres.2023.115132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 02/17/2023] [Accepted: 02/19/2023] [Indexed: 02/24/2023]
Abstract
This study compared demographic and clinical features in a sample of 384 participants: healthy controls (HC; n = 166) and individuals with schizotypal personality disorder (SPD) with (n = 50) and without (n = 168) suicidal ideation (SI) to examine specific risk factors for suicidality in SPD. Compared to the non-SI group, the SI group showed significantly greater severity of depression, aggression, impulsivity, affective lability, schizotypal features, poorer social adjustment, and had fewer social contacts. Individuals in the SI group were also more likely to have a history of a suicide attempt and comorbid borderline personality disorder in comparison to the non-SI group. Logistic regression analysis indicated that severity of depression and the number of social contacts drove the difference between the SI and non-SI groups. Compared with both SPD subgroups, the HC group was significantly less depressed, aggressive, impulsive, affectively labile, had fewer schizotypal features, was better socially adjusted, and had more social contacts. This study indicates that overall, the SI group is a more severely impaired group of individuals with SPD compared to the non-SI group. Better educating medical professionals about the diagnosis and management of SPD and its associations with suicidality is warranted.
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Affiliation(s)
- Leo Sher
- James J. Peters VA Medical Center, Bronx, NY, United States; Icahn School of Medicine at Mount Sinai, New York, NY, United States.
| | - Katelyn N Challman
- James J. Peters VA Medical Center, Bronx, NY, United States; Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Emma C Smith
- James J. Peters VA Medical Center, Bronx, NY, United States; Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Antonia S New
- James J. Peters VA Medical Center, Bronx, NY, United States; Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | | | | | - Marianne Goodman
- James J. Peters VA Medical Center, Bronx, NY, United States; Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - René S Kahn
- James J. Peters VA Medical Center, Bronx, NY, United States; Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Erin A Hazlett
- James J. Peters VA Medical Center, Bronx, NY, United States; Icahn School of Medicine at Mount Sinai, New York, NY, United States
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Post-Discharge Suicide among High-Risk Psychiatric Inpatients: Risk factors and warnings signs. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2023. [DOI: 10.1016/j.jadr.2023.100506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
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Kehoe M, Wright AM, Lee SJ, Rylatt D, Fitzgibbon BM, Meyer D, Rossell SL, Henderson K. Provision of a Multidisciplinary Post-Suicidal, Community-Based Aftercare Program: A Longitudinal Study. Community Ment Health J 2022; 59:680-691. [PMID: 36374379 DOI: 10.1007/s10597-022-01051-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 10/27/2022] [Indexed: 11/16/2022]
Abstract
Suicide is a global concern with rates in Australia continuing to increase. Effective post-suicidal care is critical for reducing persistent suicidal behaviour. One model of care is that adopted by Alfred Health, delivering a multidisciplinary, hybrid clinical and non-clinical (psycho-social support), assertive outreach approach. This study measured improvements in resilience and wellbeing, changes to distress and suicidal ideation at least 6-months post-discharge from care. Thirty-one consumers participated including a one-on-one interview to gather qualitative feedback. There was a significant change on all outcome measures with large effect sizes. Participants had significantly reduced suicidal ideation and distress and increased coping self-efficacy, hope and well-being. The qualitative findings indicated that a key component to recovery was the staff. Limitations included a low sample size, and broad time range of follow-up data collection. Providing assertive, multidisciplinary, collaborative and outreach-focused post-suicidal care can increase and sustain protective psychological factors and reduced suicidal ideation in most individuals.
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Affiliation(s)
- Michelle Kehoe
- Alfred Mental & Addiction Health (AMAH), Alfred Health, PO Box 315, Prahran, VIC, 3181, Australia. .,Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC, Australia. .,Department of Occupational Therapy, School of Allied Health Care, Monash University, Frankston, VIC, Australia.
| | - Angela M Wright
- Alfred Mental & Addiction Health (AMAH), Alfred Health, PO Box 315, Prahran, VIC, 3181, Australia
| | - Stuart J Lee
- Alfred Mental & Addiction Health (AMAH), Alfred Health, PO Box 315, Prahran, VIC, 3181, Australia.,Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC, Australia.,Centre for Forensic Behavioural Science, Swinburne University of Technology and Victorian Institute for Forensic Mental Health (Forensicare), Alphington, VIC, Australia
| | - Daniel Rylatt
- Alfred Mental & Addiction Health (AMAH), Alfred Health, PO Box 315, Prahran, VIC, 3181, Australia
| | - Bernadette Mary Fitzgibbon
- Department of Psychiatry, Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Epworth Centre for Innovation in Mental Health, Monash University and Epworth HealthCare, Melbourne, Australia
| | - Denny Meyer
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Susan L Rossell
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC, Australia.,Department of Mental Health, St Vincent's Hospital, Melbourne, VIC, Australia
| | - Kathryn Henderson
- Alfred Mental & Addiction Health (AMAH), Alfred Health, PO Box 315, Prahran, VIC, 3181, Australia
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Rangel-Malo RV, Molina-Lopez A, Jimenez-Tapia A, Lopez-Jimenez LA, Carriedo Garcia-Morato P, Gonzalez-Forteza CF. Changes After Emergency Assessment of Suicidal Patients: An Unexpected Outcome. Arch Suicide Res 2022; 26:896-911. [PMID: 33308106 DOI: 10.1080/13811118.2020.1845888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Acute Suicide Risk (ASR) is widely evaluated at Emergency Departments (ED). Little is known about follow-up of ASR after psychiatric ED evaluation, and if there are differences within No ASR (NASR) counterparts at baseline and afterwards. METHOD We developed a naturalistic, 3-month follow-up study of adult patients from a psychiatric ED in Mexico City. Depressive patients who asked voluntarily for an emergency consultation from July 1 to December 1, 2014, were included. We compared depression severity, suicidal ideation, adherence to treatment, and perceived social support scales both in ASR and NASR participants at baseline and follow-up interviews. RESULTS Participants (n = 120) were divided into ASR or NASR groups (n = 60 each). The ASR group obtained more negative scores in all scales at baseline evaluation. After three months, 85% (n = 51) of ASR and 75% (n = 45) of NASR completed the second interview. 5.21% (n = 3) of participants showed new suicidal behavior. At follow-up, the ASR group showed a higher relative response in depression scales and treatment adherence (p = 0.036), and lower scores in suicidal ideation scales than NASR group (p = 0.012). Perceived support from family was significantly higher in the NASR group (p = 0.016). DISCUSSION These relative higher responses in clinical scales suggest a paradoxical advantage of ASR over NASR patients, suggesting a hypothetical phenomenon similar to "The Tortoise and the Hare" effect. However, it is not applicable for all ASR patients. Results suggest suicidal patients experience stigma from their families. Further research and public health programs for ASR at ED should be implemented.
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Espeland K, Hjelmeland H, Loa Knizek B. A call for change from impersonal risk assessment to a relational approach: professionals' reflections on the national guidelines for suicide prevention in mental health care in Norway. Int J Qual Stud Health Well-being 2021; 16:1868737. [PMID: 33407039 PMCID: PMC7801051 DOI: 10.1080/17482631.2020.1868737] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/22/2020] [Indexed: 11/30/2022] Open
Abstract
PURPOSE The purpose of the study is to explore how professionals working with suicide prevention experience the influence of the national guidelines on mental healthcare, and to gather recommendations for which steps to take next. METHODS This is a qualitative study with an explorative design. We interviewed 22 professionals responsible for implementing suicide prevention action plans and guidelines, and/or conducting relevant research. We analysed the data by means of thematic analysis. RESULTS We found that the participants had an ambivalent view on risk assessment-it may be a tool, but it may also compromise other important aspects in prevention. Moreover, the possibility of liability has resulted in the need for self-protection. Instead, the participants recommended a relational approach to suicide prevention. CONCLUSIONS We found that the emphasis on standardized suicide risk assessment has negatively influenced suicide prevention in mental healthcare, and an approach emphasizing relational aspects is recommended. However, the prevailing objectifying concept of knowledge, the epistemological debate and the emergence of the New Public Management ideology may obstruct a fundamental emphasis on relationships. A paradigm shift in mental healthcare is called for with respect to the concept of knowledge, which forms our understandings and practices.
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Affiliation(s)
- Kristin Espeland
- Department of Mental Health, Faculty of Medicine and Health Sciences, NTNU, Trondheim, Norway
| | - Heidi Hjelmeland
- Department of Mental Health, Faculty of Medicine and Health Sciences, NTNU, Trondheim, Norway
| | - Birthe Loa Knizek
- Department of Mental Health, Faculty of Medicine and Health Sciences, NTNU, Trondheim, Norway
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Haining K, Karagiorgou O, Gajwani R, Gross J, Gumley AI, Lawrie SM, Schwannauer M, Schultze-Lutter F, Uhlhaas PJ. Prevalence and predictors of suicidality and non-suicidal self-harm among individuals at clinical high-risk for psychosis: Results from a community-recruited sample. Early Interv Psychiatry 2021; 15:1256-1265. [PMID: 33372364 PMCID: PMC8451831 DOI: 10.1111/eip.13075] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/03/2020] [Accepted: 11/15/2020] [Indexed: 01/04/2023]
Abstract
AIM Suicidal thoughts and behaviours are prevalent in individuals with schizophrenia. However, research examining the prevalence and predictors of suicidality and self-harm in participants at clinical high-risk for psychosis (CHR-P) is limited and mostly focuses on help-seeking participants recruited through clinical pathways. The current study sought to assess the prevalence of suicidality and self-harm and identify predictors of current suicidal ideation in community-recruited CHR-P participants. METHODS Data were available for 130 CHR-P participants, 15 participants with first-episode psychosis (FEP), 47 participants not fulfilling CHR-P criteria (CHR-Ns) and 53 healthy controls. Current and lifetime suicidality and self-harm were assessed using the Mini-International Neuropsychiatric Interview and the Comprehensive Assessment of At-Risk Mental States (CAARMS). Multivariable logistic regression analysis was used to determine predictors of current suicidal ideation in the CHR-P group. RESULTS A considerable proportion of CHR-P participants disclosed current suicidal ideation (34.6%). Overall, FEP individuals were at greatest risk, with considerably high prevalence rates for current suicidal ideation (73.3%), lifetime self-harm behaviour (60.0%) and lifetime suicide attempt (60.0%). In the CHR-P sample, current suicidal ideation was predicted by lifetime suicide attempts, lower CAARMS severity, impaired social functioning and greater comorbidity. CONCLUSIONS Our findings suggest that suicidality and self-harm are highly prevalent in community-recruited CHR-P and FEP individuals. Accordingly, these results highlight the importance of further research into the determinants of suicidality and self-harm during at-risk and early stages of psychosis, and the implementation of intervention strategies to reduce adverse outcomes in these populations.
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Affiliation(s)
- Kate Haining
- Institute of Neuroscience and Psychology, University of Glasgow, Scotland, UK
| | - Olga Karagiorgou
- Institute of Neuroscience and Psychology, University of Glasgow, Scotland, UK
| | - Ruchika Gajwani
- Institute of Health and Wellbeing, University of Glasgow, Scotland, UK
| | - Joachim Gross
- Institute of Neuroscience and Psychology, University of Glasgow, Scotland, UK
| | - Andrew I Gumley
- Institute of Health and Wellbeing, University of Glasgow, Scotland, UK
| | - Stephen M Lawrie
- Department of Psychiatry, University of Edinburgh, Edinburgh, Scotland, UK
| | - Matthias Schwannauer
- Department of Clinical Psychology, University of Edinburgh, Edinburgh, Scotland, UK
| | - Frauke Schultze-Lutter
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany.,Department of Psychology and Mental Health, Faculty of Psychology, Airlangga University, Surabaya, Indonesia.,University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Peter J Uhlhaas
- Institute of Neuroscience and Psychology, University of Glasgow, Scotland, UK.,Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
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Large M, Corderoy A, McHugh C. Is suicidal behaviour a stronger predictor of later suicide than suicidal ideation? A systematic review and meta-analysis. Aust N Z J Psychiatry 2021; 55:254-267. [PMID: 32579030 DOI: 10.1177/0004867420931161] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Suicidal ideation and suicidal behaviour are both regarded as important risk factors for suicide, but it is usually believed that suicidal ideation is less strongly linked to suicide than suicidal behaviours. In this study, we assessed and compared the strengths of the associations that suicidal ideation and suicidal behaviour have with later suicide using meta-analysis of primary studies reporting both these independent variables and the dependent variable of suicide. METHODS A total of 51 English language publications describing cohort or controlled studies that reported on both the association between suicidal ideation and suicide and the association between suicidal behaviours and suicide were located using searches for titles in PubMed containing variants of the word suicide (suicid*). Suicides were considered to include reported suicides and open verdicts from mortality registers. The strengths of the two associations were examined in separate random effects meta-analyses and were then compared using mixed effects meta-regression. Subgroups were examined according to study characteristics including the definitions of suicidal ideation or behaviour used, setting (psychiatric or non-psychiatric), diagnostic mix of the study population, study design (cohort or control) and study quality. RESULTS Suicidal ideation (odds ratio = 3.11, 95% confidence interval = 2.51, 3.86) and suicidal behaviours (odds ratio = 4.09, 95% confidence interval = 3.05, 5.49) were both significantly associated with suicide but there was no significant difference in the strengths of association (p = 0.14). Nor were there significant differences in the strengths of the two associations in multiple subgroup analyses. CONCLUSION Suicidal ideation and suicidal behaviour are both moderately associated with suicide. Existing data cannot conclusively demonstrate that suicidal behaviours are more strongly associated with suicide than suicidal ideation. Clinicians should not strongly prioritise suicidal behaviour over suicidal ideation when considering suicide risk.
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Affiliation(s)
- Matthew Large
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Amy Corderoy
- School of Medicine, The University of Notre Dame Australia, Sydney, NSW, Australia
| | - Catherine McHugh
- Brain and Mind Centre, The University of Sydney, Camperdown, NSW, Australia
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Corke M, Mullin K, Angel-Scott H, Xia S, Large M. Meta-analysis of the strength of exploratory suicide prediction models; from clinicians to computers. BJPsych Open 2021; 7:e26. [PMID: 33407984 PMCID: PMC8058929 DOI: 10.1192/bjo.2020.162] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Suicide prediction models have been formulated in a variety of ways and are heterogeneous in the strength of their predictions. Machine learning has been a proposed as a way of improving suicide predictions by incorporating more suicide risk factors. AIMS To determine whether machine learning and the number of suicide risk factors included in suicide prediction models are associated with the strength of the resulting predictions. METHOD Random-effect meta-analysis of exploratory suicide prediction models constructed by combining two or more suicide risk factors or using clinical judgement (Prospero Registration CRD42017059665). Studies were located by searching for papers indexed in PubMed before 15 August 2020 with the term suicid* in the title. RESULTS In total, 86 papers reported 102 suicide prediction models and included 20 210 411 people and 106 902 suicides. The pooled odds ratio was 7.7 (95% CI 6.7-8.8) with high between-study heterogeneity (I2 = 99.5). Machine learning was associated with a non-significantly higher odds ratio of 11.6 (95% CI 6.0-22.3) and clinical judgement with a non-significantly lower odds ratio of 4.7 (95% CI 2.1-10.9). Models including a larger number of suicide risk factors had a higher odds ratio when machine-learning studies were included (P = 0.02). Among non-machine-learning studies, suicide prediction models including fewer risk factors performed just as well as those including more risk factors. CONCLUSIONS Machine learning might have the potential to improve the performance of suicide prediction models by increasing the number of included suicide risk factors but its superiority over other methods is unproven.
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Affiliation(s)
- Michelle Corke
- School of Psychiatry, University of New South Wales, Australia
| | - Katherine Mullin
- South Eastern Sydney Local Health District and School of Medicine, University of Notre Dame, Australia
| | | | - Shelley Xia
- South Eastern Sydney Local Health District, Australia
| | - Matthew Large
- South Eastern Sydney Local Health District, Australia; and School of Medicine, University of Notre Dame, Australia
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McHugh CM, Corderoy A, Ryan CJ, Hickie IB, Large MM. Association between suicidal ideation and suicide: meta-analyses of odds ratios, sensitivity, specificity and positive predictive value. BJPsych Open 2019; 5:e18. [PMID: 30702058 PMCID: PMC6401538 DOI: 10.1192/bjo.2018.88] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The expression of suicidal ideation is considered to be an important warning sign for suicide. However, the predictive properties of suicidal ideation as a test of later suicide are unclear.AimsTo assess the strength of the association between suicidal ideation and later suicide measured by odds ratio (OR), sensitivity, specificity and positive predictive value (PPV). METHOD We located English-language studies indexed in PubMed that reported the expression or non-expression of suicidal ideation among people who later died by suicide or did not. A random effects meta-analysis was used to assess the pooled OR, sensitivity, specificity and PPV of suicidal ideation for later suicide among groups of people from psychiatric and non-psychiatric settings. RESULTS There was a moderately strong but highly heterogeneous association between suicidal ideation and later suicide (n = 71, OR = 3.41, 95% CI 2.59-4.49, 95% prediction interval 0.42-28.1, I2 = 89.4, Q-value = 661, d.f.(Q) = 70, P ≤0.001). Studies conducted in primary care and other non-psychiatric settings had similar pooled odds to studies of current and former psychiatric patients (OR = 3.86 v. OR = 3.23, P = 0.7). The pooled sensitivity of suicidal ideation for later suicide was 41% (95% CI 35-48) and the pooled specificity was 86% (95% CI 76-92), with high between-study heterogeneity. Studies of suicidal ideation expressed by current and former psychiatric patients had a significantly higher pooled sensitivity (46% v. 22%) and lower pooled specificity (81% v. 96%) than studies conducted in non-psychiatric settings. The PPV among non-psychiatric cohorts (0.3%, 95% CI 0.1%-0.5%) was significantly lower (Q-value = 35.6, P < 0.001) than among psychiatric samples (3.9%, 95% CI 2.2-6.6). CONCLUSIONS Estimates of the extent of the association between suicidal ideation and later suicide are limited by unexplained between-study heterogeneity. The utility of suicidal ideation as a test for later suicide is limited by a modest sensitivity and low PPV.Declaration interestM.M.L. and C.J.R. have provided expert evidence in civil, criminal and coronial matters. I.B.H. has been a Commissioner in Australia's National Mental Health Commission since 2012. He is the Co-Director, Health and Policy at the Brain and Mind Centre (BMC) University of Sydney. The BMC operates an early-intervention youth services at Camperdown under contract to Headspace. I.B.H. has previously led community-based and pharmaceutical industry-supported (Wyeth, Eli Lily, Servier, Pfizer, AstraZeneca) projects focused on the identification and better management of anxiety and depression. He is a Board Member of Psychosis Australia Trust and a member of Veterans Mental Health Clinical Reference group. He was a member of the Medical Advisory Panel for Medibank Private until October 2017. He is the Chief Scientific Advisor to, and an equity shareholder in, InnoWell. InnoWell has been formed by the University of Sydney and PricewaterhouseCoopers to administer the $30 M Australian Government Funded Project Synergy. Project Synergy is a 3-year programme for the transformation of mental health services through the use of innovative technologies.
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Affiliation(s)
| | - Amy Corderoy
- Doctor of Medicine Candidate,School of Medicine,University of Notre Dame Australia,Australia
| | - Christopher James Ryan
- Clinical Associate Professor,Consultation-Liaison Psychiatrist,Westmead Hospital,Discipline of Psychiatry; andSydney Health Ethics,University of Sydney,Australia
| | - Ian B Hickie
- Co-Director,Health and Policy,The University of Sydney Central Clinical School Brain and Mind Centre Faculty of Medicine and Health,University of Sydney,Australia
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