Assessment of suicide risk

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Suicide risk assessment is a process of estimating the likelihood for a person to attempt or die by suicide. The goal of a thorough risk assessment is to learn about the circumstances of an individual person with regard to suicide, including warning signs, risk factors, and protective factors.[1] Risk for suicide is re-evaluated throughout the course of care to assess the patient's response to personal situational changes and clinical interventions.[2]: 230  Accurate and defensible risk assessment requires a clinician to integrate a clinical judgment with the latest evidence-based practice,[3] although accurate prediction of low base rate events, such as suicide, is inherently difficult and prone to false positives.[4]

The assessment process is ethically complex: the concept of "imminent suicide" (implying the foreseeability of an inherently unpredictable act) is a legal construct in a clinical guise, which can be used to justify the rationing of emergency psychiatric resources or intrusion into patients' civil liberties.[5] Some experts recommend abandoning suicide risk assessment as it is so inaccurate.[6] In addition suicide risk assessment is often conflated with assessment of self-harm which has little overlap with suicide. Instead, it is suggested that the emotional state which has caused the suicidal thoughts, feelings or behaviour should be the focus of assessment with a view to helping the patient rather than reducing the anxiety of clinician who overestimates the risk of suicide and are fearful of litigation.[7] Given the difficulty of suicide prediction, researchers have attempted to improve the state of the art in both suicide and suicidal behavior prediction using natural language processing and machine learning applied to electronic health records.[8][9]

  1. ^ Perlman CM, Neufeld E, Martin L, Goy M, Hirdes JP (2011). "Suicide risk assessment inventory: A resource guide for Canadian health care organizations" (PDF). Toronto, ON: Ontario Hospital Association and Canadian Patient Safety Institute.
  2. ^ Barker P (2003). Psychiatric and mental health nursing: the craft of caring. London: Taylor & Francis. ISBN 978-0-340-81026-2.
  3. ^ Simon RI (2006). "Suicide risk assessment: is clinical experience enough?". The Journal of the American Academy of Psychiatry and the Law. 34 (3): 276–8. PMID 17032949.
  4. ^ Bongar B (1991). The Suicidal Patient: Clinical and Legal Standards of Care. Washington, DC: American Psychological Association. p. 63. ISBN 978-1-55798-109-7.
  5. ^ Simon RI (June 2006). "Imminent suicide: the illusion of short-term prediction". Suicide & Life-Threatening Behavior. 36 (3): 296–301. doi:10.1521/suli.2006.36.3.296. PMID 16805657.
  6. ^ Murray D (January 2016). "Is it time to abandon suicide risk assessment?". BJPsych Open. 2 (1): e1–e2. doi:10.1192/bjpo.bp.115.002071. PMC 4998936. PMID 27703761.
  7. ^ Murray D. "Suicide Risk Assessment Doesn't Work". www.scientificamerican.com. Retrieved 5 April 2017.
  8. ^ Barak-Corren Y, Castro VM, Javitt S, Hoffnagle AG, Dai Y, Perlis RH, et al. (February 2017). "Predicting Suicidal Behavior From Longitudinal Electronic Health Records". The American Journal of Psychiatry. 174 (2): 154–162. doi:10.1176/appi.ajp.2016.16010077. PMID 27609239.
  9. ^ McCoy TH, Castro VM, Roberson AM, Snapper LA, Perlis RH (October 2016). "Improving Prediction of Suicide and Accidental Death After Discharge From General Hospitals With Natural Language Processing". JAMA Psychiatry. 73 (10): 1064–1071. doi:10.1001/jamapsychiatry.2016.2172. PMC 9980717. PMID 27626235.