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Cited by 73Suicide and Self-Harm StudiesPsychiatric care and mental health servicesHomicide, Infanticide, and Child Abuse

The validity and utility of risk assessment for inpatient suicide

Large, Matthew, Ryan, Christopher, Nielssen, Olav·2011·Australasian Psychiatry
DOI 10.3109/10398562.2011.610505
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Abstract

OBJECTIVE: It is widely assumed that identifying clinical risk factors can allow us to determine which patients are at high risk of suicide while in hospital, and that identifying those patients can help prevent inpatient suicide. We aimed to examine the validity and utility of categorizing psychiatric patients to be at either high or low risk of committing suicide while in hospital. METHOD: The assumption that high-risk categorizations are valid was examined by comparing factors included in high-risk models derived from individual studies of inpatient suicide with the results of a meta-analysis of factors associated with inpatient suicide. A valid high-risk model was then applied to a hypothetical clinical setting in order to test the assumption that high-risk categorizations are useful. RESULTS: The existing models for assessing whether inpatients are at high risk of suicide all include one or more factors that were not found to be associated with inpatient suicide by meta-analysis and were probably chance associations. Depressed mood and a prior history of self-harm are the only well-established independent risk factors for inpatient suicide. Using these risk factors to classify patients as being at high or low risk would prevent few, if any, suicides, and would come at a considerable cost in terms of more restrictive care of many patients and the reduced level of care available to the remaining patients. CONCLUSIONS: Risk categorization of individual patients has no role to play in preventing the suicide of psychiatric inpatients.

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  • Known risk factors for suicide, including psychiatric and demographic variables such as depression, gender and stress, are poor predictors of short-term suicidal behavior or are non-modifiable.

    “However, these factors have quite limited clinical use: they are poor predictors of short-term behavior, or are non-modifiable (e.g., gender, past STBs).”

    From Don't Miss the Moment: A Systematic Review of Ecological Momentary Assessment in Suicide Research (2022) · cites this paper as [32]

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Authors
Large, M., Ryan, C., & Nielssen, O.
Affiliations
  • UNSW Sydney (AU)
  • The University of Sydney (AU)
Corresponding author
Large, Matthew
ORCID
Venue
Australasian Psychiatry
Publisher
SAGE Publications
Published
2011-12
Volume
19
Issue
6
Pages
507-512
ISSN
  • 1039-8562 (ISSN-L)
  • 1440-1665
DOI
10.3109/10398562.2011.610505
OpenAlex
W2075482324
Cited by
73
References
29
Citations by year
2026: 1 · 2024: 3 · 2022: 6 · 2021: 4 · 2020: 7 · 2019: 3 · 2018: 1 · 2017: 9 · 2016: 5 · 2015: 12 · 2014: 6 · 2013: 8 · 2012: 8
FWCI
7.59
Type
journal article
Language
en
Open access
closed
Licence
journals.sagepub.com/page/policies/text-and-data-mining-license (tdm)
Locations
  • Australasian Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
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
inpatient suicide, suicide risk assessment, psychiatric inpatients, depressive mood, self-harm history, suicide prevention, risk classification
MeSH terms
Suicide Prevention, Humans, Inpatients, Models, Psychological, Primary Prevention, Risk Factors, Suicide, Risk Assessment

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