Abstract
Objective: Suicide rates in veteran and military populations in the United States are high. This article reviews studies of the accuracy of methods to identify individuals at increased risk of suicide and the effectiveness and adverse effects of health care interventions relevant to U.S. veteran and military populations in reducing suicide and suicide attempts. Methods: Trials, observational studies, and systematic reviews relevant to U.S. veterans and military personnel were identified in searches of MEDLINE, PsycINFO, SocINDEX, and Cochrane databases (January 1, 2008, to September 11, 2015), on Web sites, and in reference lists. Investigators extracted and confirmed data and dual-rated risk of bias for included studies. Results: Nineteen studies evaluated accuracy of risk assessment methods, including models using retrospective electronic records data and clinician- or patient-rated instruments. Most methods demonstrated sensitivity $80% or area-under-the-curve values $.70 in single studies, including two studies based on electronic records of veterans and military personnel, but specificity varied. Suicide rates were reduced in six of eight observational studies of populationlevel interventions. Only two of ten trials of individual-level psychotherapy reported statistically significant differences between treatment and usual care. Conclusions: Risk assessment methods have been shown to be sensitive predictors of suicide and suicide attempts, but the frequency of false positives limits their clinical utility. Research to refine these methods and examine clinical applications is needed. Studies of suicide prevention interventions are inconclusive; trials of population-level interventions and promising therapies are required to support their clinical use.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 1003-1015 |
| Number of pages | 13 |
| Journal | Psychiatric Services |
| Volume | 68 |
| Issue number | 10 |
| DOIs | |
| State | Published - Oct 1 2017 |
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ASJC Scopus subject areas
- Psychiatry and Mental health
Cite this
Suicide risk assessment and prevention : A systematic review focusing on veterans. / Nelson, Heidi; Denneson, Lauren M.; Low, Allison R.; Bauer, Brian W.; O'Neil, Maya; Kansagara, Devan; Teo, Alan.
In: Psychiatric Services, Vol. 68, No. 10, 01.10.2017, p. 1003-1015.Research output: Contribution to journal › Review article
}
TY - JOUR
T1 - Suicide risk assessment and prevention
T2 - A systematic review focusing on veterans
AU - Nelson, Heidi
AU - Denneson, Lauren M.
AU - Low, Allison R.
AU - Bauer, Brian W.
AU - O'Neil, Maya
AU - Kansagara, Devan
AU - Teo, Alan
PY - 2017/10/1
Y1 - 2017/10/1
N2 - Objective: Suicide rates in veteran and military populations in the United States are high. This article reviews studies of the accuracy of methods to identify individuals at increased risk of suicide and the effectiveness and adverse effects of health care interventions relevant to U.S. veteran and military populations in reducing suicide and suicide attempts. Methods: Trials, observational studies, and systematic reviews relevant to U.S. veterans and military personnel were identified in searches of MEDLINE, PsycINFO, SocINDEX, and Cochrane databases (January 1, 2008, to September 11, 2015), on Web sites, and in reference lists. Investigators extracted and confirmed data and dual-rated risk of bias for included studies. Results: Nineteen studies evaluated accuracy of risk assessment methods, including models using retrospective electronic records data and clinician- or patient-rated instruments. Most methods demonstrated sensitivity $80% or area-under-the-curve values $.70 in single studies, including two studies based on electronic records of veterans and military personnel, but specificity varied. Suicide rates were reduced in six of eight observational studies of populationlevel interventions. Only two of ten trials of individual-level psychotherapy reported statistically significant differences between treatment and usual care. Conclusions: Risk assessment methods have been shown to be sensitive predictors of suicide and suicide attempts, but the frequency of false positives limits their clinical utility. Research to refine these methods and examine clinical applications is needed. Studies of suicide prevention interventions are inconclusive; trials of population-level interventions and promising therapies are required to support their clinical use.
AB - Objective: Suicide rates in veteran and military populations in the United States are high. This article reviews studies of the accuracy of methods to identify individuals at increased risk of suicide and the effectiveness and adverse effects of health care interventions relevant to U.S. veteran and military populations in reducing suicide and suicide attempts. Methods: Trials, observational studies, and systematic reviews relevant to U.S. veterans and military personnel were identified in searches of MEDLINE, PsycINFO, SocINDEX, and Cochrane databases (January 1, 2008, to September 11, 2015), on Web sites, and in reference lists. Investigators extracted and confirmed data and dual-rated risk of bias for included studies. Results: Nineteen studies evaluated accuracy of risk assessment methods, including models using retrospective electronic records data and clinician- or patient-rated instruments. Most methods demonstrated sensitivity $80% or area-under-the-curve values $.70 in single studies, including two studies based on electronic records of veterans and military personnel, but specificity varied. Suicide rates were reduced in six of eight observational studies of populationlevel interventions. Only two of ten trials of individual-level psychotherapy reported statistically significant differences between treatment and usual care. Conclusions: Risk assessment methods have been shown to be sensitive predictors of suicide and suicide attempts, but the frequency of false positives limits their clinical utility. Research to refine these methods and examine clinical applications is needed. Studies of suicide prevention interventions are inconclusive; trials of population-level interventions and promising therapies are required to support their clinical use.
UR - http://www.scopus.com/inward/record.url?scp=85030645187&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85030645187&partnerID=8YFLogxK
U2 - 10.1176/appi.ps.201600384
DO - 10.1176/appi.ps.201600384
M3 - Review article
C2 - 28617209
AN - SCOPUS:85030645187
VL - 68
SP - 1003
EP - 1015
JO - Psychiatric Services
JF - Psychiatric Services
SN - 1075-2730
IS - 10
ER -