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Prediction of suicidal behaviour is an aspirational goal for clinicians and policy makers; with patients classified as ‘high risk’ to be preferentially allocated treatment. Clinical usefulness requires an adequate positive predictive value (PPV).
To identify studies of predictive instruments and to calculate PPV estimates for suicidal behaviours.
A systematic review identified studies of predictive instruments. A series of meta-analyses produced pooled estimates of PPV for suicidal behaviours.
For all scales combined, the pooled PPVs were: suicide 5.5% (95% CI 3.9–7.9%), self-harm 26.3% (95% CI 21.8–31.3%) and self-harm plus suicide 35.9% (95% CI 25.8–47.4%). Subanalyses 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.
No ‘high-risk’ classification was clinically useful. Prevalence imposes a ceiling on PPV. Treatment should reduce exposure to modifiable risk factors and offer effective interventions for selected subpopulations and unselected clinical populations.
There is growing interest in brief contact interventions for self-harm
and suicide attempt.
To synthesise the evidence regarding the effectiveness of brief contact
interventions for reducing self-harm, suicide attempt and suicide.
A systematic review and random-effects meta-analyses were conducted of
randomised controlled trials using brief contact interventions (telephone
contacts; emergency or crisis cards; and postcard or letter contacts).
Several sensitivity analyses were conducted to examine study quality and
We found 14 eligible studies overall, of which 12 were amenable to
meta-analyses. For any subsequent episode of self-harm or suicide
attempt, there was a non-significant reduction in the overall pooled odds
ratio (OR) of 0.87 (95% CI 0.74–1.04, P = 0119) for
intervention compared with control. The number of repetitions per person
was significantly reduced in intervention v. control
(incidence rate ratio IRR = 066, 95% CI 0.54–0.80,
P<0001). There was no significant reduction in the
odds of suicide in intervention compared with control (OR = 0.58, 95% CI
A non-significant positive effect on repeated self-harm, suicide attempt
and suicide and a significant effect on the number of episodes of
repeated self-harm or suicide attempts per person (based on only three
studies) means that brief contact interventions cannot yet be recommended
for widespread clinical implementation. We recommend further assessment
of possible benefits in well-designed trials in clinical populations.
Previous research has shown that those employed in certain occupations, such as doctors and farmers, have an elevated risk of suicide, yet little research has sought to synthesise these findings across working-age populations.
To summarise published research in this area through systematic review and meta-analysis.
Random effects meta-analyses were used to calculate a pooled risk of suicide across occupational skill-level groups.
Thirty-four studies were included in the meta-analysis. Elementary professions (e.g. labourers and cleaners) were at elevated risk compared with the working-age population (rate ratio (RR) = 1.84, 95% CI 1.46–2.33), followed by machine operators and deck crew (RR = 1.78, 95% CI 1.22–2.60) and agricultural workers (RR = 1.64, 95% CI 1.19–2.28). Results suggested a stepwise gradient in risk, with the lowest skilled occupations being at greater risk of suicide than the highest skill-level group.
This is the first comprehensive meta-analytical review of suicide and occupation. There is a need for future studies to investigate explanations for the observed skill-level differences, particularly in people employed in lower skill-level groups.
Declaration on interest
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