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. 2017 Jul 19;12(7):e0180292.
doi: 10.1371/journal.pone.0180292. eCollection 2017.

Instruments for the assessment of suicide risk: A systematic review evaluating the certainty of the evidence

Bo Runeson  1   2 , Jenny Odeberg  3 , Agneta Pettersson  3 , Tobias Edbom  1 , Ingalill Jildevik Adamsson  4 , Margda Waern  5
Affiliations

Instruments for the assessment of suicide risk: A systematic review evaluating the certainty of the evidence

Bo Runeson et al. PLoS One. .

Abstract

Background: Instruments have been developed to facilitate suicide risk assessment. We aimed to evaluate the evidence for these instruments including assessment of risk of bias and diagnostic accuracy for suicide and suicide attempt.

Methods: PubMed (NLM), PsycInfo, Embase, Cinahl and the Cochrane Library databases were searched until December 2014. We assessed risk of bias with QUADAS-2. The average sensitivity and specificity of each instrument was estimated and the certainty of the evidence was assessed with GRADE. We considered instruments with a sensitivity > 80% and a specificity > 50% to have sufficient diagnostic accuracy.

Results: Thirty-five relevant studies were identified but 14 were considered to have high risk of bias, leaving 21 studies evaluating altogether 15 risk assessment instruments. We could carry out meta-analyses for five instruments. For the outcome suicide attempt SAD PERSONS Scale had a sensitivity of 15% (95% CI 8-24) and specificity of 97% (96-98), and the Manchester Self-Harm Rule (MSHR) a sensitivity of 97% (97-97) and a specificity of 20% (20-21). ReACT, which is a modification of MSHR, had a similar low specificity, as did the Sodersjukhuset Self Harm Rule. For the outcome suicide, the Beck Hopelessness Scale had a sensitivity of 89% (78-95) and specificity of 42% (40-43).

Conclusions: Most suicide risk assessment instruments were supported by too few studies to allow for evaluation of accuracy. Among those that could be evaluated, none fulfilled requirements for sufficient diagnostic accuracy.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flow of studies identified in literature search for systematic review on instrument for suicide risk assessment.
Fig 2
Fig 2. Meta-analyses for the diagnostic accuracy with regard to the suicide outcome.
(a) The pooled sensitivity and specificity of the instrument BHS. (b) The pooled sensitivity of the instrument ReACT. In the study by Steeg et al, two sets of populations were included, here marked as (1) and (2).
Fig 3
Fig 3. Meta-analyses for the diagnostic accuracy with regard to the outcome suicide attempts.
(a) The pooled sensitivity and specificity of the instrument MSHR. (b) The pooled sensitivity and specificity of the instrument ReACT. In the study by Steeg et al, two sets of populations were included, here marked as (1) and (2). (c) The pooled sensitivity and specificity of the instrument SoS-4. (d) The pooled sensitivity and specificity of the instrument SAD PERSONS Scale.
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