Citation

Carter G, Milner A, McGill K, Pirkis J, Kapur N, Spittal MJ. Br. J. Psychiatry 2017; 210(6): 387-395.

Affiliation

Gregory Carter, MBBS, Cert Child Psych, PhD, FRANZCP, Centre for Brain and Mental Health Research, University of Newcastle, New South Wales, Australia; Allison Milner, BJPsych (Hons), MEpi, PhD, Population Health Strategic Research Centre, Deakin University, Burwood, and Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia; Katie McGill, MPsych (Clin), DClinPsych, Centre for Brain and Mental Health Research, University of Newcastle, New South Wales, Australia; Jane Pirkis, MPsych, MAppEpid, PhD, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia; Navneet Kapur, MBChB, MMedSci, MD, FRCPsych, Centre for Suicide Prevention, Centre for Mental Health and Safety, Institute of Brain Behaviour and Mental Health, The University of Manchester, Manchester, UK; Matthew J. Spittal, MBiostat, PhD, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia.

Copyright

(Copyright © 2017, Royal College of Psychiatry)

DOI

10.1192/bjp.bp.116.182717

PMID

28302700

Abstract

BackgroundPrediction 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).AimsTo identify studies of predictive instruments and to calculate PPV estimates for suicidal behaviours.

METHODA systematic review identified studies of predictive instruments. A series of meta-analyses produced pooled estimates of PPV for suicidal behaviours.

RESULTSFor 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.

CONCLUSIONSNo '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.

© The Royal College of Psychiatrists 2017.

Language: en