TY  - JOUR
PY  - 2022//
TI  - Tools to detect risk of death by suicide: a systematic review and meta-analysis
JO  - Journal of clinical psychiatry
A1  - Riblet, Natalie B.
A1  - Matsunaga, Sarah
A1  - Lee, Younji
A1  - Young-Xu, Yinong
A1  - Shiner, Brian
A1  - Schnurr, Paula P.
A1  - Levis, Maxwell
A1  - Watts, Bradley V.
SP  - 21r14385
EP  - 21r14385
VL  - 84
IS  - 1
N2  - OBJECTIVE: There is limited knowledge about the ability of instruments to detect risk of suicide in a range of settings. Prior reviews have not considered whether the utility of instruments depends on prior probability of risk. We performed a systematic review to determine the diagnostic accuracy of instruments to detect risk of suicide in adults using likelihood ratio analysis. This method aids evaluation of prior probabilities of risk.     Data Sources: We searched MEDLINE, Cochrane Database of Systematic Reviews, PsycINFO, EMBASE, and Scopus from inception through January 19, 2021. Study Selection: We included clinical trials, observational studies, and quasi-experimental studies assessing the diagnostic accuracy of instruments to detect risk of suicide in adults. There were no language restrictions.     Data Extraction: Three reviewers in duplicate assessed full texts to determine eligibility and extracted data from included studies. Positive (LR+) and negative likelihood ratio (LR-) and 95% CIs were calculated for each instrument. <br><br>RESULTS: Thirty studies met inclusion criteria. Most instruments showed minimal utility to detect or rule out risk of suicide, with LR+ ≤ 2.0 and LR- ≥ 0.5. A few instruments had a high utility for improving risk detection in emergency department, inpatient mental health, and prison settings when patients scored above the cutoff (LR+ > 10). For example, among patients discharged from an emergency department, the Columbia Suicide Severity Rating Scale-Clinical Practice Screener had a LR+ of 10.3 (95% CI, 6.3-16.8) at 3-month follow-up. The clinical utility of the instruments depends on the pretest probability of suicide in the setting. Because studies spanned over 6 decades, the findings are at risk for secular trends. <br><br>DISCUSSION: We identified several instruments that may hold promise for detecting risk of suicide in emergency department, inpatient mental health, or prison settings. The utility of the instrument hinges, in part, on baseline suicide risk.     Registration: PROSPERO: CRD42021285528.<p />  <p>Language: en</p>
LA  - en
SN  - 0160-6689
UR  - http://dx.doi.org/10.4088/JCP.21r14385
ID  - ref1
ER  -