Predicting Suicide: Review of Risk Factors and Risk Scales

Peter M. Yellowlees, MBBS, MD


November 28, 2016

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This is the Medscape Psychiatry Minute. I'm Dr Peter Yellowlees.

We know that people with a history of self-harm are at a far greater risk for suicide than the general population. Now a team of investigators[1] from the University of Hong Kong has undertaken a systematic review and meta-analysis of prospective studies of risk factors and risk assessment scales designed to predict suicide following self-harm. Twelve studies on risk factors and seven studies on risk scales were included. Four risk factors emerged from the meta-analysis: (1) previous episodes of self-harm, (2) suicidal intent, (3) physical health problems, and (4) male sex. No scales were found to have sufficient evidence to support their use. The authors concluded that the use of scales, or an overreliance on the identification of risk factors, may provide false reassurance and is, therefore, potentially dangerous. They recommended that current best evidence specifies the continuing requirement for comprehensive psychosocial assessments of the risks and needs of people who have self-harmed to prevent consequent suicide.

This is an important study that confirms the clinical experience of most experienced physicians. None of the four risk factors identified in the review is a surprise, and all are well known. The news for us is that at this point in time, we should not be putting any substantial weight on screening tests or scales designed to predict suicide and should continue to treat all of our potentially suicidal patients in an individualized and careful way.

Thank you for listening to this Medscape Psychiatry Minute. Do enjoy your practice.


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