Predicting suicidal behaviours using clinical instruments: Systematic review and meta-analysis of positive predictive values for risk scales. (June 2017)

• Record Type: Journal Article
• Authors: Carter, Gregory; Milner, Allison; McGill, Katie; Pirkis, Jane; Kapur, Nav; Spittal, Matthew J.
• Is Part Of: British journal of psychiatry. Volume 210:Number 6(2017)
• Page Start: 387
• Page End: 395
• Publication Date: 2017-06
• Subjects: Psychiatry -- Periodicals; Psychology, Pathological -- Periodicals; 616.89005
• DOI: 10.1192/bjp.bp.116.182717
• Languages: English
• ISSNs: 0007-1250

Abstract

Abstract : 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.