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A Comparison of Suicide Risk Scales in Predicting Repeat Suicide Attempt and Suicide: A Clinical Cohort Study.
J Clin Psychiatry. 2019 11 19; 80(6)JC

Abstract

OBJECTIVE

To compare the predictive accuracy of the Suicide Intent Scale (SIS), the Suicide Assessment Scale (SUAS), the Karolinska Interpersonal Violence Scale (KIVS), and the Columbia-Suicide Severity Rating Scale (C-SSRS) for suicide attempts and suicides within 3 and 12 months of an episode of self-harm.

METHODS

This prospective multicenter cohort study included patients (N = 804) aged 18-95 years with a recent episode of self-harm assessed in psychiatric emergency settings from April 2012 to April 2016. Suicide attempts and suicides were identified in medical records and in the National Cause of Death Register. Receiver operating characteristic curves were constructed, and accuracy statistics were calculated. A sensitivity of at least 80% combined with a specificity of at least 50% were considered minimally acceptable.

RESULTS

At least 1 suicide attempt was recorded for 216 participants during follow-up, and 19 participants died by suicide. The SUAS and C-SSRS were better than chance in classifying the 114 suicide attempts occurring within the first 3 months; a C-SSRS score ≥ 27 yielded a sensitivity/specificity of 79.8%/51.5% (P < .001). During 1-year follow-up, the SUAS and C-SSRS also performed better than chance, but no cutoff on either instrument gave a sensitivity/specificity of ≥ 80%/≥ 50%. The SIS was the only instrument that could classify suicides correctly. At 3 months, the area under the curve (AUC) was 0.94 (95% CI, 0.89-0.99), and a score ≥ 21 predicted suicide with a sensitivity/specificity of 100%/81.9%, based on only 4 suicides. At 1-year follow-up, the AUC was 0.74 (95% CI, 0.61-0.87), and a score ≥ 17 predicted suicide with a sensitivity/specificity of 72.2%/57.9%.

CONCLUSIONS

Instruments that predicted nonfatal repeat suicide attempts did not predict suicide and vice versa. With the possible exception of the prediction of suicide by the SIS in a short time frame, the specificity of these instruments was low, giving them a limited relevance in the prediction of suicidal behaviors.

Authors+Show Affiliations

Vårdvägen 1, SE-112 81 Stockholm, Sweden. asa.lindh@ki.se. Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, St Görans Hospital, Stockholm, Sweden.Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, St Görans Hospital, Stockholm, Sweden.Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, St Görans Hospital, Stockholm, Sweden.Department of Clinical Sciences, Division of Psychiatry, University of Umeå, Umeå, Sweden.Department of Clinical Sciences, Division of Psychiatry, University of Umeå, Umeå, Sweden.Department of Psychiatry and Neurochemistry, University of Göteborg, Göteborg, Sweden.Department of Clinical Sciences, Division of Psychiatry, University of Umeå, Umeå, Sweden.Department of Psychiatry and Neurochemistry, University of Göteborg, Göteborg, Sweden.Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, St Görans Hospital, Stockholm, Sweden.

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

31747488

Citation

Lindh, Åsa U., et al. "A Comparison of Suicide Risk Scales in Predicting Repeat Suicide Attempt and Suicide: a Clinical Cohort Study." The Journal of Clinical Psychiatry, vol. 80, no. 6, 2019.
Lindh ÅU, Dahlin M, Beckman K, et al. A Comparison of Suicide Risk Scales in Predicting Repeat Suicide Attempt and Suicide: A Clinical Cohort Study. J Clin Psychiatry. 2019;80(6).
Lindh, Å. U., Dahlin, M., Beckman, K., Strömsten, L., Jokinen, J., Wiktorsson, S., Renberg, E. S., Waern, M., & Runeson, B. (2019). A Comparison of Suicide Risk Scales in Predicting Repeat Suicide Attempt and Suicide: A Clinical Cohort Study. The Journal of Clinical Psychiatry, 80(6). https://doi.org/10.4088/JCP.18m12707
Lindh ÅU, et al. A Comparison of Suicide Risk Scales in Predicting Repeat Suicide Attempt and Suicide: a Clinical Cohort Study. J Clin Psychiatry. 2019 11 19;80(6) PubMed PMID: 31747488.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A Comparison of Suicide Risk Scales in Predicting Repeat Suicide Attempt and Suicide: A Clinical Cohort Study. AU - Lindh,Åsa U, AU - Dahlin,Marie, AU - Beckman,Karin, AU - Strömsten,Lotta, AU - Jokinen,Jussi, AU - Wiktorsson,Stefan, AU - Renberg,Ellinor Salander, AU - Waern,Margda, AU - Runeson,Bo, Y1 - 2019/11/19/ PY - 2018/12/19/received PY - 2019/09/09/accepted PY - 2019/11/21/entrez PY - 2019/11/21/pubmed PY - 2020/5/28/medline JF - The Journal of clinical psychiatry JO - J Clin Psychiatry VL - 80 IS - 6 N2 - OBJECTIVE: To compare the predictive accuracy of the Suicide Intent Scale (SIS), the Suicide Assessment Scale (SUAS), the Karolinska Interpersonal Violence Scale (KIVS), and the Columbia-Suicide Severity Rating Scale (C-SSRS) for suicide attempts and suicides within 3 and 12 months of an episode of self-harm. METHODS: This prospective multicenter cohort study included patients (N = 804) aged 18-95 years with a recent episode of self-harm assessed in psychiatric emergency settings from April 2012 to April 2016. Suicide attempts and suicides were identified in medical records and in the National Cause of Death Register. Receiver operating characteristic curves were constructed, and accuracy statistics were calculated. A sensitivity of at least 80% combined with a specificity of at least 50% were considered minimally acceptable. RESULTS: At least 1 suicide attempt was recorded for 216 participants during follow-up, and 19 participants died by suicide. The SUAS and C-SSRS were better than chance in classifying the 114 suicide attempts occurring within the first 3 months; a C-SSRS score ≥ 27 yielded a sensitivity/specificity of 79.8%/51.5% (P < .001). During 1-year follow-up, the SUAS and C-SSRS also performed better than chance, but no cutoff on either instrument gave a sensitivity/specificity of ≥ 80%/≥ 50%. The SIS was the only instrument that could classify suicides correctly. At 3 months, the area under the curve (AUC) was 0.94 (95% CI, 0.89-0.99), and a score ≥ 21 predicted suicide with a sensitivity/specificity of 100%/81.9%, based on only 4 suicides. At 1-year follow-up, the AUC was 0.74 (95% CI, 0.61-0.87), and a score ≥ 17 predicted suicide with a sensitivity/specificity of 72.2%/57.9%. CONCLUSIONS: Instruments that predicted nonfatal repeat suicide attempts did not predict suicide and vice versa. With the possible exception of the prediction of suicide by the SIS in a short time frame, the specificity of these instruments was low, giving them a limited relevance in the prediction of suicidal behaviors. SN - 1555-2101 UR - https://www.unboundmedicine.com/medline/citation/31747488/A_Comparison_of_Suicide_Risk_Scales_in_Predicting_Repeat_Suicide_Attempt_and_Suicide:_A_Clinical_Cohort_Study_ L2 - http://www.psychiatrist.com/JCP/article/Pages/2019/v80/18m12707.aspx DB - PRIME DP - Unbound Medicine ER -