Predicting suicidal behaviours using clinical instruments: systematic review and meta-analysis of positive predictive values for risk scales.
Carter G, Milner A, McGill K, et al. Br J Psychiatry. 2017 Jun;210(6):387-395. doi: 10.1192/bjp.bp.116.182717. Epub 2017 Mar 16.
This systematic review of scales for predicting suicide shows that things remain unchanged. For all scales combined, the pooled positive predictive values were: for suicide 5.5% (95% CI 3.9-7.9%), for self-harm 26.3% (95% CI 21.8-31.3%) and for self-ham plus suicide 35.9% (95% CI 25.8-47.4%). Sub-analyses on self-harm found pooled PPVs of 16.1% (95% CI 11.3-22.3%) for high-quality studies, 32.5% (95% CI 26.1-39.6%) for hospital-treated self-harm and 26.8% (95% CI 19.5-35.6%) for psychiatric in-patients. For the moment, much to the disdain of those who believe in more objective methods and to the mutual delight of those who believe in the value of experience, clinical judgement reigns supreme.