Suicide risk assessments: why are we still relying on these a decade after the evidence showed they perform poorly?
Abstract
Suicide deaths have a profound impact on whānau and community and are a tragic loss. However, from a statistical point of view, suicide is a relatively rare event. Predicting rare events is difficult, and the implications for suicide prevention were highlighted in an important editorial in this journal more than a decade ago, yet little seems to have changed. Risk assessment that focuses on accurate prediction of suicide in real-world contexts is given a great deal of attention in mental health services, despite the fact that current scientific knowledge and best practice guidelines in this area highlight that it is unlikely to be a good basis on which to provide access to treatment. It is our view that we have a good enough understanding of the common conditions people who struggle with suicidal distress experience and energy is better directed at acting to reduce exposure to these conditions and providing treatment for those who seek it. Blueprints for successful suicide prevention exist. If we lessen the focus on prediction, we will have greater resources to focus on treatment and prevention.
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The evidence around the prediction of re-engagement in self-harm is typically based on the types of measures used in screening interventions.
“based on the evidence around the prediction of re-engagement in self-harm (Fortune 2022), typically based on the types of measures used in screening interventions”
From Prevention of self-harm and suicide in young people up to the age of 25 in education settings (2024) · cites this paper as Fortune 2022
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- Authors
- Fortune, S., & Hetrick, S.
- Affiliations
- University of Auckland (NZ)
- Corresponding author
- Fortune, Sarah
- Venue
- Australian & New Zealand Journal of Psychiatry
- Publisher
- SAGE Publications
- Published
- 2022-07-02
- Volume
- 56
- Issue
- 12
- Pages
- 1529-1534
- ISSN
- 0004-8674 (ISSN-L)
- 1440-1614
- OpenAlex
- W4283774204
- Cited by
- 16
- References
- 60
- Citations by year
- 2026: 5 · 2025: 4 · 2024: 3 · 2023: 3 · 2022: 1
- FWCI
- 2.52
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Australian & New Zealand Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- ResearchSpace (University of Auckland) (submittedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Keywords
- suicide risk assessment, suicide risk prediction, suicide prevention, rare event prediction, mental health services, access to treatment
- MeSH terms
- Suicide Prevention, Humans, Mental Health Services, Risk Assessment
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