Table 1

Selected elements and findings of three recent systematic reviews of approaches to suicide and self-harm prediction

ReviewTypes of approach includedPrimary study populationsPerformance measuresFindings and conclusions
Runeson et al 3 Psychological rating scales with risk cut-off applied
Prediction tools (unweighted variables)
Psychiatric patients (inpatient and outpatient)
Individuals presenting to emergency settings
Primary care patients
Sensitivity
Specificity
(NPV/PPV in supplement)
None achieved predefined accuracy threshold (80% sensitivity, 50% specificity). No support for use. Unclear whether may improve prediction as complement to clinical impression.
Carter et al 4 Biological measures with risk cut-off applied
Psychological rating scales with risk cut-off applied
Prediction tools (unweighted and weighted variables)
Psychiatric patients (inpatient and outpatient)
Individuals presenting to emergency settings
Military veterans
Prisoners
PPV
LR/CUI* summarised
Combined pooled PPV 26.3% for self-harm and 5.5% for suicide. No individual instrument or pooled subgroup with accuracy suitable to allocate treatment.
Belsher et al 5 Prediction models derived by various methods (including machine learning)Psychiatric patients (inpatient and outpatient)
Individuals presenting to emergency settings
Primary care patients
Military populations
General population
AUC
Accuracy
Sensitivity
PPV
Good overall classification, but low PPV. Would result in high false-positive and considerable false-negative rates if used in isolation. At present limited practical utility.
  • *Performance metrics primarily applied to diagnostic and screening tests.

  • AUC, area under the receiver operating characteristic curve; CUI, clinical utility index; LR, likelihood ratio; NPV, negative predictive value; PPV, positive predictive value.