2 e-Letters

published between 2019 and 2022

  • Comment on Favril et al.: Overstatement of the evidence for suicide risk assessment

    In a recent article Favril and associates report a systematic review and meta-analysis of risk factors for suicide derived from psychological autopsy studies that compared community samples of suicide decedents to living or deceased controls. 1 They found a range of risk factors that were, in retrospect, strongly statistically associated with suicide, including the presence of mental disorder (Odds Ratio (OR) = 13.1), depression (OR = 11.0), previous psychiatric treatment (OR = 10.1), previous self-harm (OR = 10.1), and previous suicide attempt (OR = 8.5). While acknowledging methodological weaknesses intrinsic to psychological autopsy studies, the authors maintain a position that “Identifying factors associated with suicide can improve risk stratification and help target interventions for high-risk groups” (p. 1). We consider this conclusion to be premature and fear the article will perpetuate a misplaced confidence in these risk factors as a basis for suicide risk assessment and clinical decision-making.

    Three problems deserve attention. First, more methodologically sound longitudinal studies show much weaker prospective associations between risk factors and suicide. For example, in 2017 Franklin and associates published a survey of 50 years of longitudinal research into factors associated with suicidal thoughts and behaviours, including suicide.2 The top five risk factors for suicide in the Franklin meta-analysis were previous psychiatric hospitalisation (OR = 3...

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  • Simulation training to teach medical students skills in a psychosocial intervention for alcohol related harm.

    We applaud the article by Dr Neale (1) which highlights the importance of simulation training to teach communication skills in psychiatry. However, there was no reference to the role of simulation training in teaching medical students skills in addictive medicine.
    As a result of an increase in alcohol related harm in Israel over the last 20 years (2) and recommendations (3) for controlled and replicable studies in undergraduate medical education in alcohol and substance abuse, we studied the impact of a short term intervention on the knowledge of psychiatric aspects of alcohol amongst 4th and 5th year medical students (4). The intervention consisted of a powerpoint lecture on alcohol related harm to small groups of students, followed immediately by an active member of an alcoholics anonymous group wherever possible relating his story to the material in the lecture. After 2 weeks the same group of students participated in a structured simulation of a family doctor interviewing a female adolescent because of a concern that she suffered from alcohol related harm.
    The students who did not participate directly in the simulation were asked to provide constructive feedback to the student who simulated the primary care physician along the lines of motivational interviewing (Engaging the patient, Focussing on the goals of the meeting, Evoking "change talk" by the patient as a way of introducing behavioural change and Closure of the meeting while maintaining...

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