Prediction of Suicide Attempts Using Clinician Assessment, Patient Self-report, and Electronic Health Records

Half of the people who die by suicide make a health care visit within 1 month of their death. However, clinicians lack the tools to identify these patients. To predict suicide attempts within 1 and 6 months of presentation at an emergency department (ED) for psychiatric problems. This prognostic stu...

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Bibliographic Details
Published in:JAMA network open 2022-01, Vol.5 (1), p.e2144373-e2144373
Main Authors: Nock, Matthew K, Millner, Alexander J, Ross, Eric L, Kennedy, Chris J, Al-Suwaidi, Maha, Barak-Corren, Yuval, Castro, Victor M, Castro-Ramirez, Franchesca, Lauricella, Tess, Murman, Nicole, Petukhova, Maria, Bird, Suzanne A, Reis, Ben, Smoller, Jordan W, Kessler, Ronald C
Format: Article
Language:English
Subjects:
Adult
Electronic Health Records
Female
Hispanic people
Humans
Male
Mass Screening - methods
Middle Aged
Online Only
Original Investigation
Patients
Physician-Patient Relations
Psychiatry
Risk Assessment - statistics & numerical data
Risk Factors
ROC Curve
Self Report
Suicide, Attempted - statistics & numerical data
Suicides & suicide attempts
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Summary:Half of the people who die by suicide make a health care visit within 1 month of their death. However, clinicians lack the tools to identify these patients. To predict suicide attempts within 1 and 6 months of presentation at an emergency department (ED) for psychiatric problems. This prognostic study assessed the 1-month and 6-month risk of suicide attempts among 1818 patients presenting to an ED between February 4, 2015, and March 13, 2017, with psychiatric problems. Data analysis was performed from May 1, 2020, to November 19, 2021. Suicide attempts 1 and 6 months after presentation to the ED were defined by combining data from electronic health records (EHRs) with patient 1-month (n = 1102) and 6-month (n = 1220) follow-up surveys. Ensemble machine learning was used to develop predictive models and a risk score for suicide. A total of 1818 patients participated in this study (1016 men [55.9%]; median age, 33 years [IQR, 24-46 years]; 266 Hispanic patients [14.6%]; 1221 non-Hispanic White patients [67.2%], 142 non-Hispanic Black patients [7.8%], 64 non-Hispanic Asian patients [3.5%], and 125 non-Hispanic patients of other race and ethnicity [6.9%]). A total of 137 of 1102 patients (12.9%; weighted prevalence) attempted suicide within 1 month, and a total of 268 of 1220 patients (22.0%; weighted prevalence) attempted suicide within 6 months. Clinicians' assessment alone was little better than chance at predicting suicide attempts, with externally validated area under the receiver operating characteristic curve (AUC) of 0.67 for the 1-month model and 0.60 for the 6-month model. Prediction accuracy was slightly higher for models based on EHR data (1-month model: AUC, 0.71; 6 month model: AUC, 0.65) and was best using patient self-reports (1-month model: AUC, 0.76; 6-month model: AUC, 0.77), especially when patient self-reports were combined with EHR and/or clinician data (1-month model: AUC, 0.77; and 6 month model: AUC, 0.79). A model that used only 20 patient self-report questions and an EHR-based risk score performed similarly well (1-month model: AUC, 0.77; 6 month model: AUC, 0.78). In the best 1-month model, 30.7% (positive predicted value) of the patients classified as having highest risk (top 25% of the sample) made a suicide attempt within 1 month of their ED visit, accounting for 64.8% (sensitivity) of all 1-month attempts. In the best 6-month model, 46.0% (positive predicted value) of the patients classified at highest risk made a suicide attemp
ISSN:2574-3805
2574-3805
DOI:10.1001/jamanetworkopen.2021.44373