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Review
. 2016 Jan;46(2):225-36.
doi: 10.1017/S0033291715001804. Epub 2015 Sep 15.

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

J D Ribeiro  1 , J C Franklin  1 , K R Fox  1 , K H Bentley  2 , E M Kleiman  1 , B P Chang  3 , M K Nock  1
Affiliations
Review

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

J D Ribeiro et al. Psychol Med. 2016 Jan.

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.

Keywords: Longitudinal; meta-analysis; prediction; suicidal ideation; suicide; suicide attempt.

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Figures

Fig 1
Fig 1
PRISMA diagram.
Fig 2
Fig 2
Funnel plots. Open circles represent observed estimates; shaded circles represent imputed values estimated to be missing to the left of the mean (due to publication bias). Open diamond indicates unadjusted weighted mean odds ratio; shaded diamond indicates weighted mean odds ratio adjusted for publication bias.
See this image and copyright information in PMC

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