期刊
CANADIAN JOURNAL OF PSYCHIATRY-REVUE CANADIENNE DE PSYCHIATRIE
卷 61, 期 7, 页码 428-432出版社
SAGE PUBLICATIONS INC
DOI: 10.1177/0706743716645287
关键词
clinician prediction; suicide attempt; SAD PERSONS
类别
资金
- Manitoba Health Research Council
- Canadian Institutes of Health Research [113589, 152348]
- Social Sciences and Humanities Research Council Joseph-Armand Bombardier Canada Graduate Scholarship
- University of Manitoba
Objective: Established risk assessment tools are often inaccurate at predicting future suicide risk. We therefore investigated whether clinicians are able to predict individuals' suicide risk with greater accuracy. Method: We used the SAFE Database, which included consecutive adult (age >= 18 years) presentations (N = 3818) over a 22-month period to the 2 tertiary care hospitals in Manitoba, Canada. Medical professionals assessed each individual and recorded his or her predicted risk for future suicide attempt (SA) on a 0-10 scale-the clinician prediction scale. The SAD PERSONS scale was completed as a comparison. SAs within 6 months, assessed using the Columbia Classification Algorithm for Suicide Assessment, were the primary outcome measure. Receiver operating characteristic curve and logistic regression analyses were conducted to determine the accuracy of both scales to predict SAs, and the scales were compared with z scores. Clinician prediction scale performance was stratified based on level of training. Results: Clinicians were able to predict future SAs with significantly greater accuracy (area under the curve [AUC] = 0.73; 95% CI, 0.68 to 0.77; P < 0.001) compared with the SAD PERSONS scale (z = 3.79, P < 0.001). Both scales nonetheless showed positive predictive value of less than 7%. Analyses by level of training showed that junior psychiatric residents and non-psychiatric residents did not accurately predict SAs, whereas senior psychiatric residents and staff psychiatrists demonstrated greater accuracy (AUC = 0.76 and 0.78, respectively). Conclusions: Clinicians are able to predict future attempts with fewer false positives than a conventional risk assessment scale, and this skill appears related to training level. Predicting future suicidal behaviour remains very challenging.
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