• Bibtex: @runeson2017
  • Bibliography: Runeson, B., Odeberg, J., Pettersson, A., Edbom, T., Adamsson, I. J., & Waern, M. (2017). Instruments for the assessment of suicide risk: A systematic review evaluating the certainty of the evidence. PLOS ONE, 12(7), e0180292. https://doi.org/10.1371/journal.pone.0180292

Example citation

Commonly used instruments in suicide risk do not have adequate sensitivity and specificity

My notes

  • Any instrument with >80% sens and >50% spec had sufficient accuracy
    • None of the instruments assessed met these criteria
  • It’s interesting that the PHQ-9 suicide item performs relatively well for both suicide (sens 80, spec 70) and suicide attempt (sens 78, spec 70)

We found no studies that evaluated the predictive validity of the MADRS suicide item.

Oh, really? Would probably be something valuable to do then. But there seems to have been studies since: https://pubmed.ncbi.nlm.nih.gov/35900251/


Background Instruments have been developed to facilitate suicide risk assessment. We aimed to evaluate the evidence for these instruments including assessment of risk of bias and diagnostic accuracy for suicide and suicide attempt. Methods PubMed (NLM), PsycInfo, Embase, Cinahl and the Cochrane Library databases were searched until December 2014. We assessed risk of bias with QUADAS-2. The average sensitivity and specificity of each instrument was estimated and the certainty of the evidence was assessed with GRADE. We considered instruments with a sensitivity > 80% and a specificity > 50% to have sufficient diagnostic accuracy. Results Thirty-five relevant studies were identified but 14 were considered to have high risk of bias, leaving 21 studies evaluating altogether 15 risk assessment instruments. We could carry out meta-analyses for five instruments. For the outcome suicide attempt SAD PERSONS Scale had a sensitivity of 15% (95% CI 8–24) and specificity of 97% (96–98), and the Manchester Self-Harm Rule (MSHR) a sensitivity of 97% (97–97) and a specificity of 20% (20–21). ReACT, which is a modification of MSHR, had a similar low specificity, as did the Sodersjukhuset Self Harm Rule. For the outcome suicide, the Beck Hopelessness Scale had a sensitivity of 89% (78–95) and specificity of 42% (40–43). Conclusions Most suicide risk assessment instruments were supported by too few studies to allow for evaluation of accuracy. Among those that could be evaluated, none fulfilled requirements for sufficient diagnostic accuracy. PDF: runeson_2017_instruments_for_the_assessment_of_suicide_risk_-_a_systematic_review_evaluating.pdf