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Predicting suicide: A comparison between clinical suicide risk assessment and the Suicide Intent Scale.
J Affect Disord. 2020 02 15; 263:445-449.JA

Abstract

BACKGROUND

How suicide risk should be assessed is under discussion with arguments for both actuarial and clinical approaches. The aim of the present study was to compare the predictive accuracy of a clinical suicide risk assessment to that of the Suicide Intent Scale (SIS) in predicting suicide within one year of an episode of self-harm with or without suicidal intent.

METHODS

Prospective clinical study of 479 persons assessed in a psychiatric emergency department after an episode of self-harm. The clinical risk assessment and the SIS rating were made independently of each other. Suicides within one year were identified in the National Cause of Death Register. Receiver operating characteristic (ROC) curves were constructed, optimal cut-offs were identified and accuracy statistics were calculated.

RESULTS

Of 479 participants, 329 (68.7%) were women. The age range was 18-95 years. During one-year follow up, 14 participants died by suicide. The area under the curve (AUC) for the clinical risk assessment and the SIS score were very similar, as were the accuracy statistic measures at the optimal cut-offs of the respective methods. The positive predictive value (PPV) of each assessment method was 6%.

LIMITATIONS

The clinical suicide risk assessment is not standardized. The number of suicides is small, not allowing for stratification by e.g. gender or diagnosis.

CONCLUSION

Predictive accuracy was similar for a clinical risk assessment and the SIS, and insufficient to guide treatment allocation.

Authors+Show Affiliations

Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, S:t Görans Hospital, Stockholm, Sweden. Electronic address: asa.lindh@ki.se.Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, S:t Görans Hospital, Stockholm, Sweden.Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, S:t Görans Hospital, Stockholm, Sweden.Department of Psychiatry and Neurochemistry, University of Gothenburg & Region Västra Götaland, Sahlgrenska University Hospital, Psychosis Department, Gothenburg, Sweden.Department of Clinical Sciences, Division of Psychiatry, University of Umeå, Sweden.Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, S:t Görans Hospital, Stockholm, Sweden.Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, S:t Görans Hospital, Stockholm, Sweden.

Pub Type(s)

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

Language

eng

PubMed ID

31969276

Citation

Lindh, Åsa U., et al. "Predicting Suicide: a Comparison Between Clinical Suicide Risk Assessment and the Suicide Intent Scale." Journal of Affective Disorders, vol. 263, 2020, pp. 445-449.
Lindh ÅU, Beckman K, Carlborg A, et al. Predicting suicide: A comparison between clinical suicide risk assessment and the Suicide Intent Scale. J Affect Disord. 2020;263:445-449.
Lindh, Å. U., Beckman, K., Carlborg, A., Waern, M., Salander Renberg, E., Dahlin, M., & Runeson, B. (2020). Predicting suicide: A comparison between clinical suicide risk assessment and the Suicide Intent Scale. Journal of Affective Disorders, 263, 445-449. https://doi.org/10.1016/j.jad.2019.11.131
Lindh ÅU, et al. Predicting Suicide: a Comparison Between Clinical Suicide Risk Assessment and the Suicide Intent Scale. J Affect Disord. 2020 02 15;263:445-449. PubMed PMID: 31969276.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Predicting suicide: A comparison between clinical suicide risk assessment and the Suicide Intent Scale. AU - Lindh,Åsa U, AU - Beckman,Karin, AU - Carlborg,Andreas, AU - Waern,Margda, AU - Salander Renberg,Ellinor, AU - Dahlin,Marie, AU - Runeson,Bo, Y1 - 2019/11/30/ PY - 2019/07/17/received PY - 2019/10/27/revised PY - 2019/11/29/accepted PY - 2020/1/24/pubmed PY - 2020/1/24/medline PY - 2020/1/24/entrez KW - Self-harm KW - Suicide KW - Suicide Intent Scale KW - Suicide attempt KW - Suicide risk assessment SP - 445 EP - 449 JF - Journal of affective disorders JO - J Affect Disord VL - 263 N2 - BACKGROUND: How suicide risk should be assessed is under discussion with arguments for both actuarial and clinical approaches. The aim of the present study was to compare the predictive accuracy of a clinical suicide risk assessment to that of the Suicide Intent Scale (SIS) in predicting suicide within one year of an episode of self-harm with or without suicidal intent. METHODS: Prospective clinical study of 479 persons assessed in a psychiatric emergency department after an episode of self-harm. The clinical risk assessment and the SIS rating were made independently of each other. Suicides within one year were identified in the National Cause of Death Register. Receiver operating characteristic (ROC) curves were constructed, optimal cut-offs were identified and accuracy statistics were calculated. RESULTS: Of 479 participants, 329 (68.7%) were women. The age range was 18-95 years. During one-year follow up, 14 participants died by suicide. The area under the curve (AUC) for the clinical risk assessment and the SIS score were very similar, as were the accuracy statistic measures at the optimal cut-offs of the respective methods. The positive predictive value (PPV) of each assessment method was 6%. LIMITATIONS: The clinical suicide risk assessment is not standardized. The number of suicides is small, not allowing for stratification by e.g. gender or diagnosis. CONCLUSION: Predictive accuracy was similar for a clinical risk assessment and the SIS, and insufficient to guide treatment allocation. SN - 1573-2517 UR - https://www.unboundmedicine.com/medline/citation/31969276/Predicting_suicide:_A_comparison_between_clinical_suicide_risk_assessment_and_the_Suicide_Intent_Scale_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0165-0327(19)31849-X DB - PRIME DP - Unbound Medicine ER -