The DOI matches its Crossref record, with a small difference in title or year; 43 of the 46 references it cites were found in a registry or an index.
Prediction Models for Suicide Attempts and Deaths: A Systematic Review and Simulation
Abstract
Importance: Suicide prediction models have the potential to improve the identification of patients at heightened suicide risk by using predictive algorithms on large-scale data sources. Suicide prediction models are being developed for use across enterprise-level health care systems including the US Department of Defense, US Department of Veterans Affairs, and Kaiser Permanente. Objectives: To evaluate the diagnostic accuracy of suicide prediction models in predicting suicide and suicide attempts and to simulate the effects of implementing suicide prediction models using population-level estimates of suicide rates. Evidence Review: A systematic literature search was conducted in MEDLINE, PsycINFO, Embase, and the Cochrane Library to identify research evaluating the predictive accuracy of suicide prediction models in identifying patients at high risk for a suicide attempt or death by suicide. Each database was searched from inception to August 21, 2018. The search strategy included search terms for suicidal behavior, risk prediction, and predictive modeling. Reference lists of included studies were also screened. Two reviewers independently screened and evaluated eligible studies. Findings: From a total of 7306 abstracts reviewed, 17 cohort studies met the inclusion criteria, representing 64 unique prediction models across 5 countries with more than 14 million participants. The research quality of the included studies was generally high. Global classification accuracy was good (≥0.80 in most models), while the predictive validity associated with a positive result for suicide mortality was extremely low (≤0.01 in most models). Simulations of the results suggest very low positive predictive values across a variety of population assessment characteristics. Conclusions and Relevance: To date, suicide prediction models produce accurate overall classification models, but their accuracy of predicting a future event is near 0. Several critical concerns remain unaddressed, precluding their readiness for clinical applications across health systems.
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In the citing paper
“Even complex risk assessment models do not allow for precise prediction of suicidal behavior (26, 27)”
From Suicide risk assessment: clinical implications of the unpredictability of suicidal behavior (2026) · cites this paper as [27]
In the citing paper
“and, in particular, they do not allow for prediction of the time at which suicidal behavior will occur.”
From Suicide risk assessment: clinical implications of the unpredictability of suicidal behavior (2026) · cites this paper as [27]
In the citing paper
“In principle, it is important to acknowledge that events with a low base rate, such as suicide attempts and suicides, can never be precisely predicted-no matter which assessments and methods are used (Belsher et al., 2019;Bryan, 2021).”
From Suicide Crisis Syndrome: A systematic review (2024) · cites this paper as Belsher et al., 2019
In the citing paper
“most models had a PPV <1% for predicting suicide mortality”
From Accuracy requirements for cost-effective suicide risk prediction among primary care patients in the US (2021) · cites this paper as [10]
In the citing paper
“multiple research groups have developed suicide risk prediction models using electronic health record data.10,11,12,13”
From Accuracy requirements for cost-effective suicide risk prediction among primary care patients in the US (2021) · cites this paper as [10]
In the citing paper
“A recent systematic review10 identified 17 such predictive models that have been described in the literature.”
From Accuracy requirements for cost-effective suicide risk prediction among primary care patients in the US (2021) · cites this paper as [10]
In the citing paper
“A 2019 review of 64 longitudinal suicide prediction models36 found most models reported extremely low (ie, <.01) PPVs, such that 99 out of every 100 individuals predicted by these models to attempt suicide will not.”
From A pilot study using frequent inpatient assessments of suicidal thinking to predict short-term postdischarge suicidal behavior (2021) · cites this paper as [36]
In the citing paper
“The dynamic feature model predicted posthospital suicide attempts with good accuracy (AUC, 0.89), which is at the high end of the range of reported AUC values for longitudinal prediction models of suicidal behaviors.36”
From A pilot study using frequent inpatient assessments of suicidal thinking to predict short-term postdischarge suicidal behavior (2021) · cites this paper as [36]
In the citing paper
“In comparison, the average cross-validated PPV for our dynamic feature model was 0.39. This represents a substantial improvement beyond both previous work and our baseline and mean models”
From A pilot study using frequent inpatient assessments of suicidal thinking to predict short-term postdischarge suicidal behavior (2021) · cites this paper as [36]
In the citing paper
“Although machine learning methods have yielded high AUCs, the PPV of most models has been low.”
From A pilot study using frequent inpatient assessments of suicidal thinking to predict short-term postdischarge suicidal behavior (2021) · cites this paper as [36]
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Positive Predictive Values and Potential Success of Suicide Prediction Models
Matarazzo, B. B., Brenner, L. A., & Reger, M. A. (2019) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2019.1519 · Cited by 15
Large, M. M. B., Soper, C. A., & Ryan, C. J. (2022) · The Lancet Psychiatry · doi:10.1016/s2215-0366(22)00314-5 · Cited by 15
Karnick, A. T., Fergerson, A. K., Caulfield, N. M., Buerke, M. L., Albanese, B. J., Schmidt, N. B., & Capron, D. W. (2022) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2022.07.050 · Cited by 14
Validation of a Multivariable Model to Predict Suicide Attempt in a Mental Health Intake Sample
Papini, S., Hsin, H., Kipnis, P., Liu, V. X., Lu, Y., Girard, K., Sterling, S., & Iturralde, E. (2024) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2024.0189 · Cited by 14
Predicting Suicides Among US Army Soldiers After Leaving Active Service
Kennedy, C. J., Kearns, J. C., Geraci, J. C., Gildea, S. M., Hwang, I. H., King, A. J., Liu, H., Luedtke, A. R., Marx, B. P., Papini, S., et al. (2024) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2024.2744 · Cited by 14
Littlefield, A. K., Cooke, J. T., Bagge, C. L., Glenn, C. R., Kleiman, E. M., Jacobucci, R., Millner, A. J., & Steinley, D. (2021) · Clinical Psychological Science · doi:10.1177/2167702620961067 · Cited by 15
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The Ethics of Risk Prediction for Psychosis and Suicide Attempt in Youth Mental Health
Smith, W., Appelbaum, P. S., Lebowitz, M. S., Gülöksüz, S., Calkins, M. E., Kohler, C. G., Gur, R. E., & Barzilay, R. (2023) · The Journal of Pediatrics · doi:10.1016/j.jpeds.2023.113583 · Cited by 14
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Risk Model–Guided Clinical Decision Support for Suicide Screening
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Metadata
- Authors
- Belsher, B. E., Smolenski, D. J., Pruitt, L. D., Bush, N. E., Beech, E. H., Workman, D. E., Morgan, R. L., Evatt, D. P., Tucker, J., & Skopp, N. A.
- Affiliations
- Uniformed Services University of the Health Sciences (US)
- Defense Health Agency (US)
- McMaster University (CA)
- ORCID
- Venue
- JAMA Psychiatry
- Publisher
- American Medical Association (AMA)
- Published
- 2019-06-01
- Volume
- 76
- Issue
- 6
- Pages
- 642
- ISSN
- 2168-622X (ISSN-L)
- OpenAlex
- W2921616123
- Cited by
- 540
- References
- 46
- Citations by year
- 2026: 81 · 2025: 73 · 2024: 63 · 2023: 63 · 2022: 82 · 2021: 83 · 2020: 64 · 2019: 31
- FWCI
- 10.24
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- JAMA Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Health Sciences › Health Professions › Health Information Management › Artificial Intelligence in Healthcare
- Physical Sciences › Computer Science › Artificial Intelligence › Machine Learning in Healthcare
- Keywords
- suicide attempts, suicide mortality, diagnostic accuracy, predictive validity, positive predictive value, risk prediction, clinical implementation, health care system
- MeSH terms
- Algorithms, Humans, Models, Theoretical, Suicide, Suicide, Attempted, Suicidal Ideation
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