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The Suicide Risk Assessment and Management Manual (S-RAMM) Validation Study II

Published online by Cambridge University Press:  13 June 2014

John Fagan
Affiliation:
Central Mental Hospital, Dundrum
Atif Ijaz
Affiliation:
Central Mental Hospital, Dundrum
Alexia Papaconstantinou
Affiliation:
Central Mental Hospital, Dundrum
Aideen Lynch
Affiliation:
Central Mental Hospital, Dundrum
Helen O'Neill
Affiliation:
University of Dublin, Trinity College
Harry G Kennedy*
Affiliation:
Central Mental Hospital, Dundrum, Dublin 14 University of Dublin, Trinity College, Ireland.
*
*Correspondence E-mail: harry.kennedy@ireland.com

Abstract

Objectives: Structured professional judgement is now the most widely accepted approach to clinical risk assessment and risk management. The Suicide Risk Assessment and Management Manual (S-RAMM) is a new structured professional judgement tool closely modelled on the HCR-20. This is the first prospective validation study for this instrument.

Methods: Two post-membership registrars jointly interviewed 81 of 83 current inpatients to rate the S-RAMM. Two assistant psychologists independently rated the HCR-20, GAF and PANSS. All incidents of self-harm, attempted suicide, suicide and violence to others were collated from hospital reporting of critical incidents over the next six months supplemented by examination of other records.

Results: For combined self-harm and suicide outcomes, the S-RAMM total score using the receiver operating characteristic had an area under the curve AUC=0.89, (95% CI 0.79 to 0.99). The S-RAMM performed as well for the prediction of self-harm and suicide as the HCR-20 did for violence, and better than measures of mental state (PANSS total score) and global function (GAF).

Conclusions: The S-RAMM has better than minimum acceptable characteristics for use as a clinical or research tool for suicide risk assessment, and performs almost as well as the HCR-20 does for violence. Further prospective studies are now required, in other populations.

Type
Original Papers
Copyright
Copyright © Cambridge University Press 2009

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