Self-injurious thoughts and behaviors as risk factors for future suicide ideation, attempts, and death: a meta-analysis of longitudinal studies

Abstract

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.

Sociodemographic Variables Most Associated with Suicidal Behaviour and Suicide Methods in Europe and America. A Systematic Review

“…Ruling out that there are no third persons involved (when it is not the case of a suicide) is a key factor in the legal field and during judicial proceedings. Furthermore, if we compare this SR with other recent publications Huang, Ribeiro, Musacchio, & Franklin, 2017;Ribeiro et al, 2016), we could find that this SR allows us to have relevant information in a single study regarding the variables that are more closely associated to suicidal behaviour (sex, age, marital status, employment status, residence area, education), the most commonly used suicide methods, and the relationship between all variables. In addition, the database used and the year range selected (ten years) allows us to have a very complete, comprehensive, and quality information.…”

Letter to the Editor: Suicide as a complex classification problem: machine learning and related techniques can advance suicide prediction - a reply to Roaldset (2016)

“…We posit that predicting future suicidal thoughts and behaviors will be at least as difficult as matching a user's search query to a relevant webpage. A search engine that would rely on a single factor alone would be highly ineffective; likewise, as demonstrated by Ribeiro et al (2016), prediction of suicide ideation, attempt, and death using a single factor also is highly inaccurate. This was also demonstrated by Bentley et al (2016) in a meta-analysis of anxiety disorders and symptoms as risk factors for suicidal thoughts and behaviors.…”

Letter to the Editor: Self-injurious thoughts and behaviours: low predictive power, yet important risk factors?

“…This result is seemingly in contrast to a widespread belief in the field that prior SITBs are some of the most important risk factors of future SITBs, and especially prior suicidal attempts has been regarded a robust risk factor for future suicide (Ribeiro et al 2016). …”

“…In a recent and valuable review, Ribeiro et al conclude that self-injurious thoughts and behaviours (SITBs) only provide a marginal improvement above chance in diagnostic accuracy for later suicidal thoughts and behaviours (Ribeiro et al 2016). This result is seemingly in contrast to a widespread belief in the field that prior SITBs are some of the most important risk factors of future SITBs, and especially prior suicidal attempts has been regarded a robust risk factor for future suicide (Ribeiro et al 2016).…”