Suicide risk assessment: Risk stratification is not accurate enough to be clinically useful and alternative approaches are needed


Gregory Carter, Matthew J Spittal.


In clinical populations, suicidal behaviors are future events that should be the focus of prevention. Risk assessments are done to classify individuals as high risk or low risk for future suicidal behaviors. However, the inaccuracy of suicide prediction has been known for 60 years. Three accuracy measures help to understand the high-risk classification as the basis for allocation of interventions. Several systematic reviews and meta-analyses meet (or nearly meet) standards for reporting of diagnostic and predictive tests and have established estimates for the key accuracy statistics. The most common single factor used to classify high risk for suicide is suicidal ideation. Despite substantial effort over decades to identify risk factors and develop predictive instruments, risk stratification is too inaccurate to be clinically useful and might even be harmful. An alternative approach comprising a needs assessment, identification of modifiable risk factors, and use of effective interventions should be employed to guide management. Future research could be directed away from risk stratification and toward a better understanding of needs, specific modifiable risk factors, and effective intervention. ÉVALUATION-CLINIQUE DÉPISTAGE POTENTIEL-SUICIDAIRE INTERVENTION

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