Suicide risk assessment and prevention

A systematic review focusing on veterans

Heidi Nelson, Lauren M. Denneson, Allison R. Low, Brian W. Bauer, Maya O'Neil, Devan Kansagara, Alan Teo

Research output: Contribution to journalReview article

8 Citations (Scopus)

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 languageEnglish (US)
Pages (from-to)1003-1015
Number of pages13
JournalPsychiatric Services
Volume68
Issue number10
DOIs
StatePublished - Oct 1 2017

Fingerprint

Veterans
Suicide
Military Personnel
Observational Studies
Population
MEDLINE
Psychotherapy
Area Under Curve
Research Personnel
Databases
Delivery of Health Care
Therapeutics
Research

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 journalReview article

Nelson, Heidi ; Denneson, Lauren M. ; Low, Allison R. ; Bauer, Brian W. ; O'Neil, Maya ; Kansagara, Devan ; Teo, Alan. / Suicide risk assessment and prevention : A systematic review focusing on veterans. In: Psychiatric Services. 2017 ; Vol. 68, No. 10. pp. 1003-1015.
@article{1f7474f7628d4ac7beaee24609fd5dce,
title = "Suicide risk assessment and prevention: A systematic review focusing on veterans",
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.",
author = "Heidi Nelson and Denneson, {Lauren M.} and Low, {Allison R.} and Bauer, {Brian W.} and Maya O'Neil and Devan Kansagara and Alan Teo",
year = "2017",
month = "10",
day = "1",
doi = "10.1176/appi.ps.201600384",
language = "English (US)",
volume = "68",
pages = "1003--1015",
journal = "Psychiatric Services",
issn = "1075-2730",
publisher = "American Psychiatric Association",
number = "10",

}

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

VL - 68

SP - 1003

EP - 1015

JO - Psychiatric Services

JF - Psychiatric Services

SN - 1075-2730

IS - 10

ER -