Predicting suicidal behaviours using clinical instruments: Systematic review and meta-analysis of positive predictive values for risk scales
Open accessAbstract
Background: Prediction of suicidal behaviour is an aspirational goal for clinicians and policy makers; with patients classified as ‘high risk’ to be preferentially allocated treatment. Clinical usefulness requires an adequate positive predictive value (PPV). Aims: To identify studies of predictive instruments and to calculate PPV estimates for suicidal behaviours. Method: A systematic review identified studies of predictive instruments. A series of meta-analyses produced pooled estimates of PPV for suicidal behaviours. Results: For all scales combined, the pooled PPVs were: suicide 5.5% (95% CI 3.9–7.9%), self-harm 26.3% (95% CI 21.8–31.3%) and self-harm plus suicide 35.9% (95% CI 25.8–47.4%). Subanalyses on self-harm found pooled PPVs of 16.1% (95% CI 11.3–22.3%) for high-quality studies, 32.5% (95% CI 26.1–39.6%) for hospital-treated self-harm and 26.8% (95% CI 19.5–35.6%) for psychiatric in-patients. Conclusions: No ‘high-risk’ classification was clinically useful. Prevalence imposes a ceiling on PPV. Treatment should reduce exposure to modifiable risk factors and offer effective interventions for selected subpopulations and unselected clinical populations.
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Risk stratification using assessment tools is not sufficiently accurate for prediction of suicide risk in clinical use.
“Risk stratification using assessment tools is not sufficiently accurate for prediction of suicide risk in clinical use”
The sole use of ICD-9/10 diagnosis codes in EHRs to document STB has proven insufficient.
“While International Classification of Disease (ICD-9/10) diagnosis codes in EHRs are used to document STB, their sole use has proven insufficient14.”
From Deep learning for identifying personal and family history of suicidal thoughts and behaviors from EHRs (2024) · cites this paper as [14]
The paper’s CUI+ and clinical-assessment sections evaluate the accuracy of suicide-risk scales for predicting future behaviour. They do not address whether ICD-9/10 codes alone adequately document suicidal thoughts and behaviours in EHRs; searches for ICD-9, diagnosis codes, and electronic health records found no passage on that point. (LLM, conf=0.77)
Experimental — accuracy not yet measuredComputerised adaptive testing enables more efficient, flexible and precise administration of individual-reported outcome measures.
“Computerised adaptive testing enables more efficient, flexible and precise administration of individual-reported outcome measures. 630”
From Time for united action on depression: a Lancet–World Psychiatric Association Commission (2022) · cites this paper as [630]
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“Risk stratification using assessment tools is not sufficiently accurate for prediction of suicide risk in clinical use; instead clinical assessment should focus on modifiable risk factors that could be targeted to reduce the risk (53).”
MethodTime for united action on depression: a Lancet–World Psychiatric Association Commission
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- Authors
- Carter, G., Milner, A., McGill, K., Pirkis, J., Kapur, N., & Spittal, M. J.
- Affiliations
- Deakin University (AU)
- Venue
- British Journal of Psychiatry
- Publisher
- Royal College of Psychiatrists
- Published
- 2017-06
- Volume
- 210
- Issue
- 6
- Pages
- 387-395
- ISSN
- 0007-1250 (ISSN-L)
- 1472-1465
- OpenAlex
- W2596790840
- Cited by
- 361
- References
- 106
- Citations by year
- 2026: 41 · 2025: 28 · 2024: 39 · 2023: 38 · 2022: 49 · 2021: 31 · 2020: 48 · 2019: 39 · 2018: 35 · 2017: 13
- FWCI
- 5.66
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The British Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Own your potential (DEAKIN) (submittedVersion)
- Figshare (submittedVersion, cc-by)
- Minerva Access (University of Melbourne) (submittedVersion)
- Research Explorer (The University of Manchester) (submittedVersion, other-oa)
- NOVA (University of Newcastle Australia) (submittedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Social Sciences › Sociology and Political Science › Homicide, Infanticide, and Child Abuse
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Keywords
- suicidal behavior, suicide risk prediction, positive predictive value, risk assessment scale, self-harm, suicide, clinical utility, high-risk classification, psychiatric inpatients, modifiable risk factors
- MeSH terms
- Humans, Predictive Value of Tests, Psychiatric Status Rating Scales, Suicide, Suicide, Attempted, Self-Injurious Behavior
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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