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Instruments for the assessment of suicide risk: A systematic review evaluating the certainty of the evidence

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  • Bo Runeson
  • Jenny Odeberg
  • Agneta Pettersson
  • Tobias Edbom
  • Ingalill Jildevik Adamsson
  • Margda Waern

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.

Suggested Citation

  • Bo Runeson & Jenny Odeberg & Agneta Pettersson & Tobias Edbom & Ingalill Jildevik Adamsson & Margda Waern, 2017. "Instruments for the assessment of suicide risk: A systematic review evaluating the certainty of the evidence," PLOS ONE, Public Library of Science, vol. 12(7), pages 1-13, July.
  • Handle: RePEc:plo:pone00:0180292
    DOI: 10.1371/journal.pone.0180292
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    Cited by:

    1. Carl B. Roth & Andreas Papassotiropoulos & Annette B. Brühl & Undine E. Lang & Christian G. Huber, 2021. "Psychiatry in the Digital Age: A Blessing or a Curse?," IJERPH, MDPI, vol. 18(16), pages 1-32, August.
    2. Emilijus Žilinskas & Giedrė Žulpaitė & Kristijonas Puteikis & Rima Viliūnienė, 2021. "Mental Health among Higher Education Students during the COVID-19 Pandemic: A Cross-Sectional Survey from Lithuania," IJERPH, MDPI, vol. 18(23), pages 1-14, December.
    3. Rose-Marie Lindkvist & Sofie Westling & Sophia Eberhard & Björn Axel Johansson & Olof Rask & Kajsa Landgren, 2021. "‘A Safe Place Where I Am Welcome to Unwind When I Choose to’—Experiences of Brief Admission by Self-Referral for Adolescents Who Self-Harm at Risk for Suicide: A Qualitative Study," IJERPH, MDPI, vol. 19(1), pages 1-15, December.
    4. Sally Hultsjö & Rikard Wärdig & Patrik Rytterström, 2019. "The borderline between life and death: Mental healthcare professionals’ experience of why patients commit suicide during ongoing care," Journal of Clinical Nursing, John Wiley & Sons, vol. 28(9-10), pages 1623-1632, May.
    5. Qi Chen & Yanli Zhang-James & Eric J Barnett & Paul Lichtenstein & Jussi Jokinen & Brian M D’Onofrio & Stephen V Faraone & Henrik Larsson & Seena Fazel, 2020. "Predicting suicide attempt or suicide death following a visit to psychiatric specialty care: A machine learning study using Swedish national registry data," PLOS Medicine, Public Library of Science, vol. 17(11), pages 1-19, November.

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