- Title
- Predicting suicidal behaviours using clinical instruments: systematic review and meta-analysis of positive predictive values for risk scales
- Creator
- Carter, Gregory; Milner, Allison; McGill, Katie; Pirkis, Jane; Kapur, Nav; Spittal, Matthew J.
- Relation
- British Journal of Psychiatry Vol. 210, Issue 6, p. 387-395
- Publisher Link
- http://dx.doi.org/10.1192/bjp.bp.116.182717
- Publisher
- Cambridge University Press
- Resource Type
- journal article
- Date
- 2017
- Description
- Background: Prediction 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). Aims: To identify studies of predictive instruments and to calculate PPV estimates for suicidal behaviours. Method: A systematic review identified studies of predictive instruments. A series of meta-analyses produced pooled estimates of PPV for suicidal behaviours. Results: For 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. Conclusions: No '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.
- Subject
- suicide; suicide prevention; suicide behaviours; prediction
- Identifier
- http://hdl.handle.net/1959.13/1394582
- Identifier
- uon:33730
- Identifier
- ISSN:0007-1250
- Language
- eng
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