Risk factors for suicidal thoughts and behaviors: A meta-analysis of 50 years of research.

Abstract

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

Risikoabschätzung bei suizidalen Patienten: Geht das überhaupt?

“…Die Befundlage wird im Folgenden zunächst skizziert und die Bedeutung dieser Befunde für die Risikoabschätzung im klinischen Alltag anschließend reflektiert. Franklin et al [2017] Chan et al, 2016;Ribeiro et al, 2016;Carter et al, 2017;Huang et al, 2017]. Dies gilt umso mehr, da die allerwenigsten Personen, die Suizidgedanken haben oder einen Suizidversuch unternommen haben, durch einen Suizid sterben [Carroll et al, 2014] und die allermeisten Personen, die sich suizidieren, im unmittelbaren Vorfeld Suizidgedanken verneinen [Smith et al, 2013] bzw.…”

“…keinen vorherigen Suizidversuch unternommen haben [Cavanagh et al, 2003]. Franklin et al [2017] fassen als Ergebnis ihrer Metaanalyse entsprechend zusammen, dass in den vergangenen 50 Jahren kein substantieller Fortschritt hinsichtlich der Vorhersage suizidalen Verhaltens erreicht wurde. Gleichzeitig ist die Aussagekraft der Analyse für die klinische Praxis begrenzt: Kein Therapeut begründet seine Risikoabschätzung im klinischen Alltag mit dem Vorliegen von ein bis zwei Einzelfaktoren, sondern stützt sich auf einen komplexen klinischen Eindruck.…”

Kan vi forutsi selvmord?

“…There are many statistical risk factors for suicide, but they are of limited value in an acute suicide crisis (10). In that situation, it is more important to identify whether the patient has suicidal thoughts and plans for suicide, how concrete those plans are, whether they are present all the time or intermittently, whether the patient is hearing voices telling her what to do, and whether the patient is agitated, has access to means such as weapons or medication, and has no plans for the future (11).…”

Smartphone-Based Safety Planning and Self-Monitoring for Suicidal Patients: A Conceptual Basis for the CASPAR (Continuous Assessment for Suicide Prevention and Research) Study

“…Our understanding of the factors associated with suicide has grown in recent decades, but it is still unclear how those factors interact with each other [2]. As a consequence of this indistinctness, suicidal risk factors are of limited clinical use in the identification of individuals who are most at risk of acting on their thoughts of suicide [1,3,4].…”

“…Suicidal behaviour results from a complex interaction between biological, social and psychological factors (e.g., gender, the experience of stressful life events and mental disorders) [1,2]. Our understanding of the factors associated with suicide has grown in recent decades, but it is still unclear how those factors interact with each other [2].…”