Citation

Fagan J, Ijaz A, Papaconstantinou A, Lynch A, O'Neill H, Kennedy HG. Ir. J. Psychol. Med. 2009; 26(3): 107-113.

Affiliation

Central Mental Hospital,Dundrum,Dublin 14.

Copyright

(Copyright © 2009, Irish Institute of Psychological Medicine)

DOI

10.1017/S0790966700000380

PMID

30282303

Abstract

OBJECTIVES: Structured professional judgement is now the most widely accepted approach to clinical risk assessment and risk management. The Suicide Risk Assessment and Management Manual (S-RAMM) is a new structured professional judgement tool closely modelled on the HCR-20. This is the first prospective validation study for this instrument.

METHODS: Two post-membership registrars jointly interviewed 81 of 83 current inpatients to rate the S-RAMM. Two assistant psychologists independently rated the HCR-20, GAF and PANSS. All incidents of self-harm, attempted suicide, suicide and violence to others were collated from hospital reporting of critical incidents over the next six months supplemented by examination of other records.

RESULTS: For combined self-harm and suicide outcomes, the S-RAMM total score using the receiver operating characteristic had an area under the curve AUC=0.89, (95% CI 0.79 to 0.99). The S-RAMM performed as well for the prediction of self-harm and suicide as the HCR-20 did for violence, and better than measures of mental state (PANSS total score) and global function (GAF).

CONCLUSIONS: The S-RAMM has better than minimum acceptable characteristics for use as a clinical or research tool for suicide risk assessment, and performs almost as well as the HCR-20 does for violence. Further prospective studies are now required, in other populations.

Language: en