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Risk factors for suicide in adults: systematic review and meta-analysis of psychological autopsy studies
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  • Published on:
    Comment on Favril et al.: Overstatement of the evidence for suicide risk assessment
    • C. A. Soper, Psychologist Private practice, Lisbon, Portugal
    • Other Contributors:
      • Matthew M. Large, Professor, School of Psychiatry

    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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    Conflict of Interest:
    None declared.