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- Published on: 7 June 2023
- Published on: 10 October 2022
- Published on: 7 June 2023Suicide risk factors and risk assessment – Authors' reply
In our meta-analysis, we synthesised evidence on risk factors for suicide based on psychological autopsy studies [1]. We included data from 37 case-control studies and examined associations for 40 risk factors in 12,734 adults. Novel aspects are the inclusion of a wide range of risk factors across four domains – sociodemographic, family history, clinical, and life events – and quantitative methods to examine sources of heterogeneity.
In their response, Soper and Large question one interpretation to the findings (rather than methods, analyses, or reporting) stating that consideration of risk factors and risk assessment has limited clinical utility. We think that this is a misreading of the evidence.
First, assessing the risk of suicide and linking assessment to preventative measures is a central component of clinical care. We suggest that prediction models can assist in stratifying an individual’s suicide risk. One advantage of empirically derived prediction models over subjective clinical judgment is that they attempt to incorporate the relative strength of multiple risk factors and their interactions. In addition, subjective clinical judgement tends to be optimistic with an over-reliance on recent events [2]. Furthermore, risk assessment tools can improve consistency within and between clinical services. They can also raise the ceiling of expertise, particularly where high staff turnover and variations in training experience exist, and anchor decision-maki...
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SF was part of team that developed OxMIS and OxSATS. - Published on: 10 October 2022Comment on Favril et al.: Overstatement of the evidence for suicide risk assessment
In a recent article Favril and associates report a systematic review and meta-analysis of risk factors for suicide derived from psychological autopsy studies that compared community samples of suicide decedents to living or deceased controls. 1 They found a range of risk factors that were, in retrospect, strongly statistically associated with suicide, including the presence of mental disorder (Odds Ratio (OR) = 13.1), depression (OR = 11.0), previous psychiatric treatment (OR = 10.1), previous self-harm (OR = 10.1), and previous suicide attempt (OR = 8.5). While acknowledging methodological weaknesses intrinsic to psychological autopsy studies, the authors maintain a position that “Identifying factors associated with suicide can improve risk stratification and help target interventions for high-risk groups” (p. 1). We consider this conclusion to be premature and fear the article will perpetuate a misplaced confidence in these risk factors as a basis for suicide risk assessment and clinical decision-making.
Three problems deserve attention. First, more methodologically sound longitudinal studies show much weaker prospective associations between risk factors and suicide. For example, in 2017 Franklin and associates published a survey of 50 years of longitudinal research into factors associated with suicidal thoughts and behaviours, including suicide.2 The top five risk factors for suicide in the Franklin meta-analysis were previous psychiatric hospitalisation (OR = 3...
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None declared.