Suicidal thoughts and behaviors (STBs) are major public health problems that have not declined appreciably in several decades. One of the first steps to improving the prevention and treatment of STBs is to establish risk factors (i.e., longitudinal predictors). To provide a summary of current knowledge about risk factors, we conducted a meta-analysis of studies that have attempted to longitudinally predict a specific STB-related outcome. This included 365 studies (3,428 total risk factor effect sizes) from the past 50 years. The present random-effects meta-analysis produced several unexpected findings: across odds ratio, hazard ratio, and diagnostic accuracy analyses, prediction was only slightly better than chance for all outcomes; no broad category or subcategory accurately predicted far above chance levels; predictive ability has not improved across 50 years of research; studies rarely examined the combined effect of multiple risk factors; risk factors have been homogenous over time, with 5 broad categories accounting for nearly 80% of all risk factor tests; and the average study was nearly 10 years long, but longer studies did not produce better prediction. The homogeneity of existing research means that the present meta-analysis could only speak to STB risk factor associations within very narrow methodological limits-limits that have not allowed for tests that approximate most STB theories. The present meta-analysis accordingly highlights several fundamental changes needed in future studies. In particular, these findings suggest the need for a shift in focus from risk factors to machine learning-based risk algorithms. (PsycINFO Database Record

Background A history of self-injurious thoughts and behaviors (SITBs) is consistently cited as one of the strongest predictors of future suicidal behavior. However, stark discrepancies in the literature raise questions about the true magnitude of these associations. The objective of this study is to examine the magnitude and clinical utility of the associations between SITBs and subsequent suicide ideation, attempts, and death. Method We searched PubMed, PsycInfo, and Google Scholar for papers published through December 2014. Inclusion required that studies include at least one longitudinal analysis predicting suicide ideation, attempts, or death using any SITB variable. We identified 2179 longitudinal studies; 172 met inclusion criteria. Results The most common outcome was suicide attempt (47.80%), followed by death (40.50%) and ideation (11.60%). Median follow-up was 52 months (mean = 82.52, s.d. = 102.29). Overall prediction was weak, with weighted mean odds ratios (ORs) of 2.07 [95% confidence interval (CI) 1.76–2.43] for ideation, 2.14 (95% CI 2.00–2.30) for attempts, and 1.54 (95% CI 1.39–1.71) for death. Adjusting for publication bias further reduced estimates. Diagnostic accuracy analyses indicated acceptable specificity (86–87%) and poor sensitivity (10–26%), with areas under the curve marginally above chance (0.60–0.62). Most risk factors generated OR estimates of <2.0 and no risk factor exceeded 4.5. Effects were consistent regardless of sample severity, sample age groups, or follow-up length. Conclusions Prior SITBs confer risk for later suicidal thoughts and behaviors. However, they only provide a marginal improvement in diagnostic accuracy above chance. Addressing gaps in study design, assessment, and underlying mechanisms may prove useful in improving prediction and prevention of suicidal thoughts and behaviors.

clinicaltrials.gov Identifier: NCT01243606.

Nonsuicidal self-injury (NSSI) is a prevalent and dangerous phenomenon associated with many negative outcomes, including future suicidal behaviors. Research on these behaviors has primarily focused on correlates; however, an emerging body of research has focused on NSSI risk factors. To provide a summary of current knowledge about NSSI risk factors, we conducted a meta-analysis of published, prospective studies longitudinally predicting NSSI. This included 20 published reports across 5078 unique participants. Results from a random-effects model demonstrated significant, albeit weak, overall prediction of NSSI (OR = 1.59; 95% CI: 1.50 to 1.69). Among specific NSSI risk factors, prior history of NSSI, cluster b, and hopelessness yielded the strongest effects (ORs > 3.0); all remaining risk factor categories produced ORs near or below 2.0. NSSI measurement, sample type, sample age, and prediction case measurement type (i.e., binary versus continuous) moderated these effects. Additionally, results highlighted several limitations of the existing literature, including idiosyncratic NSSI measurement and few studies among samples with NSSI histories. These findings indicate that few strong NSSI risk factors have been identified, and suggest a need for examination of novel risk factors, standardized NSSI measure ment, and study samples with a history of NSSI.

Objective There are many barriers to accessing mental health assessments including cost and stigma. Even when individuals receive professional care, assessments are intermittent and may be limited partly due to the episodic nature of psychiatric symptoms. Therefore, machine‐learning technology using speech samples obtained in the clinic or remotely could one day be a biomarker to improve diagnosis and treatment. To date, reviews have only focused on using acoustic features from speech to detect depression and schizophrenia. Here, we present the first systematic review of studies using speech for automated assessments across a broader range of psychiatric disorders. Methods We followed the Preferred Reporting Items for Systematic Reviews and Meta‐Analysis (PRISMA) guidelines. We included studies from the last 10 years using speech to identify the presence or severity of disorders within the Diagnostic and Statistical Manual of Mental Disorders (DSM‐5). For each study, we describe sample size, clinical evaluation method, speech‐eliciting tasks, machine learning methodology, performance, and other relevant findings. Results 1395 studies were screened of which 127 studies met the inclusion criteria. The majority of studies were on depression, schizophrenia, and bipolar disorder, and the remaining on post‐traumatic stress disorder, anxiety disorders, and eating disorders. 63% of studies built machine learning predictive models, and the remaining 37% performed null‐hypothesis testing only. We provide an online database with our search results and synthesize how acoustic features appear in each disorder. Conclusion Speech processing technology could aid mental health assessments, but there are many obstacles to overcome, especially the need for comprehensive transdiagnostic and longitudinal studies. Given the diverse types of data sets, feature extraction, computational methodologies, and evaluation criteria, we provide guidelines for both acquiring data and building machine learning models with a focus on testing hypotheses, open science, reproducibility, and generalizability. Level of Evidence 3a

The need to capture severity and impairment of depressive symptomatology is widespread. Existing depression scales are lengthy and largely focus on individual symptoms rather than resulting impairment. The Overall Depression Severity and Impairment Scale (ODSIS) is a 5-item, continuous measure designed for use across heterogeneous mood disorders and with subthreshold depressive symptoms. This study examined the psychometric properties of the ODSIS in outpatients in a clinic for emotional disorders (N = 100), undergraduate students (N = 566), and community-based adults (N = 189). Internal consistency, latent structure, item response theory, classification accuracy, convergent and discriminant validity, and differential item functioning analyses were conducted. ODSIS scores exhibited excellent internal consistency, and confirmatory factor analyses supported a unidimensional structure. Item response theory results demonstrated that the ODSIS provides more information about individuals with high levels of depression than those with low levels of depression. Responses on the ODSIS discriminated well between individuals with and without a mood disorder and depression-related severity across clinical and subclinical levels. A cut score of 8 correctly classified 82% of outpatients as with or without a mood disorder; it evidenced a favorable balance of sensitivity and specificity and of positive and negative predictive values. The ODSIS demonstrated good convergent and discriminant validity, and results indicate that items function similarly across clinical and nonclinical samples. Overall, findings suggest that the ODSIS is a valid tool for measuring depression-related severity and impairment. The brevity and ease of use of the ODSIS support its utility for screening and monitoring treatment response across a variety of settings.

Suicidal thoughts and behaviors are highly prevalent public health problems with devastating consequences. There is an urgent need to improve our understanding of risk factors for suicide to identify effective intervention targets. The aim of this meta-analysis was to examine the magnitude and clinical utility of anxiety and its disorders as risk factors for suicide ideation, attempts, and deaths. We conducted a literature search through December 2014; of the 65 articles meeting our inclusion criteria, we extracted 180 cases in which an anxiety-specific variable was used to longitudinally predict a suicide-related outcome. Results indicated that anxiety is a statistically significant, yet weak, predictor of suicide ideation (OR=1.49, 95% CI: 1.18, 1.88) and attempts (OR=1.64, 95% CI: 1.47, 1.83), but not deaths (OR=1.01, 95% CI: 0.87, 1.18). The strongest associations were observed for PTSD. Estimates were reduced after accounting for publication bias, and diagnostic accuracy analyses indicated acceptable specificity but poor sensitivity. Overall, the extant literature suggests that anxiety and its disorders, at least when these constructs are measured in isolation and as trait-like constructs, are relatively weak predictors of suicidal thoughts and behaviors over long follow-up periods. Implications for future research priorities are discussed.

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