| アブストラクト | Assessment of suicide risk in individuals with severe mental illness is currently inconsistent, and based on clinical decision-making with or without tools developed for other purposes. We aimed to develop and validate a predictive model for suicide using data from linked population-based registers in individuals with severe mental illness. A national cohort of 75,158 Swedish individuals aged 15-65 with a diagnosis of severe mental illness (schizophrenia-spectrum disorders, and bipolar disorder) with 574,018 clinical patient episodes between 2001 and 2008, split into development (58,771 patients, 494 suicides) and external validation (16,387 patients, 139 suicides) samples. A multivariable derivation model was developed to determine the strength of pre-specified routinely collected socio-demographic and clinical risk factors, and then tested in external validation. We measured discrimination and calibration for prediction of suicide at 1 year using specified risk cut-offs. A 17-item clinical risk prediction model for suicide was developed and showed moderately good measures of discrimination (c-index 0.71) and calibration. For risk of suicide at 1 year, using a pre-specified 1% cut-off, sensitivity was 55% (95% confidence interval [CI] 47-63%) and specificity was 75% (95% CI 74-75%). Positive and negative predictive values were 2% and 99%, respectively. The model was used to generate a simple freely available web-based probability-based risk calculator (Oxford Mental Illness and Suicide tool or OxMIS) without categorical cut-offs. A scalable prediction score for suicide in individuals with severe mental illness is feasible. If validated in other samples and linked to effective interventions, using a probability score may assist clinical decision-making. |
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| ジャーナル名 | Translational psychiatry |
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| Pubmed追加日 | 2019/2/26 |
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| 投稿者 | Fazel, Seena; Wolf, Achim; Larsson, Henrik; Mallett, Susan; Fanshawe, Thomas R |
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| 組織名 | Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK.;seena.fazel@psych.ox.ac.uk.;Department of Medical Epidemiology and Biostatistics, Karolinska Institutet,;Stockholm, Sweden.;School of Medical Sciences, Orebro University, Orebro, Sweden.;School of Population and Health Sciences, University of Birmingham, Birmingham,;UK.;Nuffield Department of Primary Care Health Sciences, University of Oxford,;Oxford, UK. |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/30804323/ |
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