Can we usefully stratify patients according to suicide risk?
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In the UK, one in five adults has considered suicide at some time, and one in 15 has attempted suicide. Half of those who attempt suicide seek help afterwards—a quarter from a GP, a quarter from a hospital or specialist medical or psychiatric service. Suicidal patients; patients who present to health services with suicidal ideas, self harm, or suicide attempts; and patients who present as significantly distressed or mentally ill can be challenging to manage. Doctors are often advised to use suicide risk assessment to help them decide management plans. A wide variety of risk factors have been implicated in the stratification of potentially suicidal patients. This stratification is often expressed in terms of high, medium, or low-risk. In practice, doctors commonly give the greatest importance to suicidal ideation. In some specialist mental health settings these judgments are aided by local risk assessment forms composed of lists of clinical and demographic factors, while other centres use risk strata derived from validated questionnaires or scales. However, there is little consensus over their use and virtually no evidence that any of the method of suicide risk stratification can contribute to suicide prevention.
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Individual prediction of suicides in persons with psychiatric disorders remains very difficult.
“Although many risk factors are known for suicidality in persons with psychiatric disorders, individual prediction of suicides remains very difficult (34).”
From Assisted suicide in persons with mental disorders: a review of clinical-ethical arguments and recommendations (2024) · cites this paper as [34]
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Self-citationThe Role of Big Data Analytics in Predicting Suicide
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Lohani, M., Bryan, C. J., Elsey, J. S., Dutton, S., Findley, S. P., Langenecker, S. A., West, K., & Baker, J. C. (2024) · Journal of Affective Disorders · doi:10.1016/j.jad.2024.06.004 · Cited by 20 · see citing works
On the Randomness of Suicide: An Evolutionary, Clinical Call to Transcend Suicide Risk Assessment
Soper, C. A., Ocejo, P. M., & Large, M. M. (2022) · Evolutionary Psychiatry · doi:10.1017/9781009030564.011 · Cited by 16 · see citing works
Self-citationMarckmann, G., & Pollmächer, T. (2024) · Annals of Palliative Medicine · doi:10.21037/apm-23-472 · Cited by 14 · see citing works
- Authors
- Large, M. M., Ryan, C. J., Carter, G., & Kapur, N.
- Affiliations
- UNSW Sydney (AU)
- The University of Sydney (AU)
- University of Newcastle Australia (AU)
- Corresponding author
- Large, Matthew Michael
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2017-10-17
- Volume
- 359
- Pages
- j4627
- ISSN
- 1756-1833 (ISSN-L)
- 0959-8138
- OpenAlex
- W2763440556
- Cited by
- 112
- References
- 5
- Citations by year
- 2026: 10 · 2025: 16 · 2024: 8 · 2023: 9 · 2022: 13 · 2021: 7 · 2020: 21 · 2019: 16 · 2018: 11 · 2017: 1
- FWCI
- 16.62
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- BMJ (publishedVersion)
- PubMed (publishedVersion)
- Figshare (submittedVersion, cc-by-nc)
- HighWire Press Open Archive (submittedVersion)
- Research Explorer (The University of Manchester) (submittedVersion, other-oa)
- NOVA (University of Newcastle Australia) (submittedVersion, cc-by-nc)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Social Sciences › Sociology and Political Science › Homicide, Infanticide, and Child Abuse
- Keywords
- suicide risk assessment, suicide risk stratification, suicidal ideation, suicide attempts, self-harm, suicide prevention, risk assessment questionnaire, mental health services, primary care
- MeSH terms
- Suicide Prevention, Humans, Predictive Value of Tests, Psychological Tests, Risk Factors, Suicide, Self-Injurious Behavior, Risk Assessment, Suicidal Ideation
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