Tools to Detect Risk of Death by Suicide

Riblet, Natalie; Matsunaga, Sarah; Lee, Younji; Young‐Xu, Yinong; Shiner, Brian; Schnurr, Paula P.; Levis, Maxwell; Watts, Bradley V.

doi:10.4088/jcp.21r14385

Cited by 8 publications

(6 citation statements)

References 65 publications

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“…This recommendation was recently confirmed by Riblet et al. ( 25 ) using likelihood ratio analysis. However, there are few independent studies on the effectiveness of these tools as a preventive measure.…”

Section: Introductionmentioning

confidence: 56%

“…Based on these results and the literature, we would like to summarize some points that may be relevant when selecting an appropriate instrument in practice. First, predictive validity is similar ( 19 , 25 ). However, independent and prospective studies are not available.…”

Section: Discussionmentioning

confidence: 97%

“…Although their use is the subject of critical debate, suicide screening instruments are generally recommended for use in the prison system ( 13 ). This study examined two suicide screening instruments (SIRAS and VISCI) in a sample of males inmates in a Berlin prison that were recently recommended by reviews ( 19 , 25 ).…”

Section: Discussionmentioning

confidence: 99%

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Comparison of two suicide screening instruments for identifying high-risk individuals in prison

Hausam,

Calvano,

Opitz-Welke

2024

Front. Psychiatry

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Increased suicide rates in prison are a serious concern. Early identification of inmates at risk is a component of effective suicide prevention. The present study examined two suicide screening instruments in a sample of men in the Berlin, Germany, prison system (n = 289). The Screening for Initial Risk Assessment (SIRAS) identified significantly more high-risk inmates than the Vienna Instrument for Suicidality in Correctional Institutions (VISCI) (66 vs. 24). The results further show that the agreement in the classification was evident only in inmates with suicidal ideation, but was otherwise quite low. This can be explained by the fact that the instruments differ in terms of the risk factors taken into account. Finally, it was found that inmates classified as high risk received more monitoring and psychiatric or psychological support, which supports the construct validity of the instruments. As there were no deaths by suicide in the sample, no statistical information on the predictive validity of the instruments could be provided. Although research in this area is challenging, methodologically sound studies are needed to inform practice.

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Section: Introductionmentioning

confidence: 56%

Section: Discussionmentioning

confidence: 97%

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Comparison of two suicide screening instruments for identifying high-risk individuals in prison

Hausam,

Calvano,

Opitz-Welke

2024

Front. Psychiatry

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“…As these individuals inherently constitute a high-risk population, there is evidence that prior information might influence diagnostic accuracy ( 35 ). For instance, in other areas like suicidality, the diagnostic accuracy of structured methods appears to depend on prior information, such as previous suicide attempts ( 36 ). This leads to the conclusion that cut-off points derived from other studies of the BVC and V-RISK-10 may not be directly applicable to high-risk populations.…”

Section: Discussionmentioning

confidence: 99%

The predictive validity of the V-RISK-10 and BVC among involuntarily admitted patients

Kös,

Bräunig,

Hausam

2024

Front. Psychiatry

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Although endangerment towards others is a criterion for an involuntary admission in many countries, research on risk assessment of endangerment among involuntarily admitted individuals is limited. In this retrospective case-control study, we calculated scores for a German-translated version of the Violence Risk Screening-10 (V-RISK-10) and the Brøset Violence Checklist (BVC) in a sample of 111 people undergoing an involuntary admission in Reinickendorf, Berlin. Outcomes were violence, coercive measures, and readmission. In line with our hypotheses, the BVC demonstrated stronger predictive validities for short-term, and V-RISK-10 for long-term events. There was an incremental validity for both instruments for restraint 24 hours after admission and any violence until discharge. These findings support the evidence that structured risk assessment instruments may be useful for individuals undergoing an involuntary admission. Ethical considerations about screening procedures are discussed.

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“…Approximately 5% of patients treated for depression in primary care report suicidal ideation “more than half the days” or “nearly every day” in response to item 9 of the PHQ-9, and those patients have an approximately 1% risk of self-harm or suicide attempt over the following 90 days . Data from mental health specialty or inpatient samples suggest that structured assessments, such as the Columbia-Suicide Severity Rating Scale, can identify individuals with current or recent suicidal ideation for whom specialty consultation is recommended and those with suicidal planning and intent for whom urgent consultation or referral is recommended. When same- or next-day specialty consultation is not available, primary care clinicians can collaborate with patients and caregivers to create a safety plan or crisis response plan that includes steps to reduce access to lethal means, such as firearms.…”

Section: Discussionmentioning

confidence: 99%

Management of Depression in Adults

Simon,

Moise,

Mohr

2024

JAMA

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ImportanceApproximately 9% of US adults experience major depression each year, with a lifetime prevalence of approximately 17% for men and 30% for women.ObservationsMajor depression is defined by depressed mood, loss of interest in activities, and associated psychological and somatic symptoms lasting at least 2 weeks. Evaluation should include structured assessment of severity as well as risk of self-harm, suspected bipolar disorder, psychotic symptoms, substance use, and co-occurring anxiety disorder. First-line treatments include specific psychotherapies and antidepressant medications. A network meta-analysis of randomized clinical trials reported cognitive therapy, behavioral activation, problem-solving therapy, interpersonal therapy, brief psychodynamic therapy, and mindfulness-based psychotherapy all had at least medium-sized effects in symptom improvement over usual care without psychotherapy (standardized mean difference [SMD] ranging from 0.50 [95% CI, 0.20-0.81] to 0.73 [95% CI, 0.52-0.95]). A network meta-analysis of randomized clinical trials reported 21 antidepressant medications all had small- to medium-sized effects in symptom improvement over placebo (SMD ranging from 0.23 [95% CI, 0.19-0.28] for fluoxetine to 0.48 [95% CI, 0.41-0.55] for amitriptyline). Psychotherapy combined with antidepressant medication may be preferred, especially for more severe or chronic depression. A network meta-analysis of randomized clinical trials reported greater symptom improvement with combined treatment than with psychotherapy alone (SMD, 0.30 [95% CI, 0.14-0.45]) or medication alone (SMD, 0.33 [95% CI, 0.20-0.47]). When initial antidepressant medication is not effective, second-line medication treatment includes changing antidepressant medication, adding a second antidepressant, or augmenting with a nonantidepressant medication, which have approximately equal likelihood of success based on a network meta-analysis. Collaborative care programs, including systematic follow-up and outcome assessment, improve treatment effectiveness, with 1 meta-analysis reporting significantly greater symptom improvement compared with usual care (SMD, 0.42 [95% CI, 0.23-0.61]).Conclusions and RelevanceEffective first-line depression treatments include specific forms of psychotherapy and more than 20 antidepressant medications. Close monitoring significantly improves the likelihood of treatment success.

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Tools to Detect Risk of Death by Suicide

Cited by 8 publications

References 65 publications

Comparison of two suicide screening instruments for identifying high-risk individuals in prison

Comparison of two suicide screening instruments for identifying high-risk individuals in prison

The predictive validity of the V-RISK-10 and BVC among involuntarily admitted patients

Management of Depression in Adults

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