A new study casts doubt on the effectiveness of assessments of suicide risk by medical professionals.
The meta-analysis, led by clinical psychiatrist and Conjoint Professor Dr. Matthew Large from the University of New South Wales in Australia, found that suicide risk assessment tools were not successful in predicting suicide outcomes. It found no evidence of scientific progress over the past 50 years, pointing to a need for a more patient-focused approach to crisis mental health care.
“It is widely assumed that the care of psychiatric patients can be guided by a mental health professional’s estimate of suicide risk and by using patient characteristics to define high-risk patients,” Large said. “However, the reliability of categorizing suicide risk remains unknown.”
The study investigated the odds of suicide in high-risk compared to lower-risk categories and the suicide rates in these two groups. The researchers say they reviewed every long-term prospective study of suicide risk assessment published worldwide over the past 50 years.
What they found is there was no reliable method for assessing suicide risk, with the results of the assessments varying enormously across the 37 studies reviewed. They found half of all suicides occurred in lower-risk groups, while 95 percent of high-risk patients did not commit suicide.
Overall, the study demonstrated that suicide risk assessments provide results that are slightly better than chance. However, complex methods of suicide risk assessment that take into account multiple risk factors offer no statistical advantage than using a single factor, the researchers noted.
“Much of what happens when a mentally distressed person presents to a hospital depends on a suicide risk assessment, based on a whole range of risk factors,” Large said. “Lower-risk patients can be denied treatment, while some high-risk patients get hospitalized, sometimes against their wishes, based on an inaccurate risk assessment.
“In many hospitals, resources are still being allocated on the basis of suicide risk,” he continued. “It is time we moved away from paternalist medical decision-making and classifying people into suicide risk categories.
“If a patient presents with a suicide crisis they should be thoroughly assessed, without categorization. Mental health professionals must also involve patients in the decision-making process about their ongoing care to improve their outcomes.”
The study was published in the PLOS ONE journal.