Summary of Journal Article:
Instruments for the assessment of suicide risk: A systematic review evaluating the certainty of the evidence
This systematic review article aimed to evaluate the evidence of the current available suicide risk assessment instruments, including risk of bias, diagnostic accuracy for suicide and for suicide attempt.
Methods:
This systematic review set forth the following inclusion criteria: studies are to be prospective and conducted in psychiatric and primary care settings, the studies are required to evaluate the sensitivity and specificity for suicidal acts with actual rates of suicidal and suicide attempts, sample size must be a minimum of 50 participants and published in 1990 or later. Eligible studies were assessed for risk of bias. A meta-analysis was performed it at least two studies with at least 200 individuals each were available for a specific instrument and outcome. Certainty of evidence was also assessed. 21 studies met the inclusion criteria and had low risk of bias.
Assessment instruments reviewed: Patient Health Questionnaire (PHQ-9), Beck’s Hopelessness scale (BHS), Columbia Suicide Severity Rating Scale (C-SSRS), Beck Depression Inventory (BDI), Scale for Suicide Ideation-Current (SSI-C), Scale for Suicide Ideation-Worst (SSI-W), Patient Health Questionnaire (PHQ-9) suicide item, Beck’s Suicide Intent Scale (SIS), Suicide Assessment Scale (SUAS), Manchester Self-Harm Rule (MSHR), ReACT, Sodersjukhuset Self-Harm Rule (SOS-4), SAD PERSONS scale, modified SAD PERSONS Scale, MINI-International Neuropsychiatric Interview suicide module, Edinburg Risk of Repetition Scale (ERRS) and the Suicide Probability Scale (SPS)
To determine assessment of utility the instrument needed to have reached 80% sensitivity and 50% specificity which none of them did. Low values were chosen due to the severity of the outcomes studied.
Discussion/Conclusion:
The Scale for Suicide Ideation and Suicidal Intent Scale showed low sensitivity, but the certainty of evidence was low to moderate, further research needs to be conducted on those two.
Strong evidence suggests the SAD PERSONS Scale has low diagnostic accuracy, and should not be used in its present form. (SAD PERSONS Scale had a sensitivity of 15% and specificity of 97%, Manchester Self-Harm Rule had a sensitivity of 97% and a specificity of 20%)
The Manchester Self Harm and Sodersjukhuset Self Harm Rule had high sensitivity but very low specificity.
15 instruments qualified for assessment, of which none of them actually showed sufficient diagnostic accuracy, even with the lenient limits for sensitivity and specificity set forth.
Most didn’t have enough evidence to support their use, and ones that did have enough evidence didn’t fulfill the requirements to make them sufficient for diagnostic accuracy.
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0180292#sec013
