OBJECTIVE: Determining risk for a suicide attempt in psychiatric patients requires assessment of multiple risk factors and knowledge of their relative importance. Classification and regression tree (CART) analysis generates decision trees that select the variables that perform best in identifying the group of interest and model clinical decision making. Hypothetical decision trees to identify recent and remote suicide attempters, weighted to increase sensitivity, were generated for psychiatric patients using correlates of past suicidal behavior. METHOD: Correlates of past suicide attempts were identified in 408 patients with mood, schizophrenia spectrum, or personality disorders (DSM-IV). Correlated variables were entered into recursive partitioning statistical models to generate equally weighted and unequally weighted hypothetical decision trees for distinguishing recent (</= 30 days prior to study) and remote (> 250 days prior to study) suicide attempters from nonattempters. The study was conducted from December 1989 to November 1998. RESULTS: In equally weighted trees, a recent past suicide attempt was best predicted by current suicidal ideation (sensitivity = 56%, specificity = 91%, positive predictive value = 69%), and no adequate model was found for remote attempts. In unequally weighted models, recent attempters were identified by suicidal ideation and comorbid borderline personality disorder (sensitivity = 73%, specificity = 80%, positive predictive value = 58%). Remote attempters were identified by lifetime aggression and current subjective depression (sensitivity = 89%, specificity = 36%, positive predictive value = 44%). CONCLUSION: Current suicidal ideation is the best indicator of a recent suicide attempt in psychiatric patients. Indicators of a remote attempt are aggressive traits and current depression. Weighted decision trees can improve sensitivity and miss fewer attempters but with a cost in specificity.
OBJECTIVE: Determining risk for a suicide attempt in psychiatricpatients requires assessment of multiple risk factors and knowledge of their relative importance. Classification and regression tree (CART) analysis generates decision trees that select the variables that perform best in identifying the group of interest and model clinical decision making. Hypothetical decision trees to identify recent and remote suicide attempters, weighted to increase sensitivity, were generated for psychiatricpatients using correlates of past suicidal behavior. METHOD: Correlates of past suicide attempts were identified in 408 patients with mood, schizophrenia spectrum, or personality disorders (DSM-IV). Correlated variables were entered into recursive partitioning statistical models to generate equally weighted and unequally weighted hypothetical decision trees for distinguishing recent (</= 30 days prior to study) and remote (> 250 days prior to study) suicide attempters from nonattempters. The study was conducted from December 1989 to November 1998. RESULTS: In equally weighted trees, a recent past suicide attempt was best predicted by current suicidal ideation (sensitivity = 56%, specificity = 91%, positive predictive value = 69%), and no adequate model was found for remote attempts. In unequally weighted models, recent attempters were identified by suicidal ideation and comorbid borderline personality disorder (sensitivity = 73%, specificity = 80%, positive predictive value = 58%). Remote attempters were identified by lifetime aggression and current subjective depression (sensitivity = 89%, specificity = 36%, positive predictive value = 44%). CONCLUSION: Current suicidal ideation is the best indicator of a recent suicide attempt in psychiatricpatients. Indicators of a remote attempt are aggressive traits and current depression. Weighted decision trees can improve sensitivity and miss fewer attempters but with a cost in specificity.
Authors: J K Lönnqvist; M M Henriksson; E T Isometsä; M J Marttunen; M E Heikkinen; H M Aro; K I Kuoppasalmi Journal: Psychiatry Clin Neurosci Date: 1995-05 Impact factor: 5.188
Authors: A C Leon; M B Keller; M G Warshaw; T I Mueller; D A Solomon; W Coryell; J Endicott Journal: Am J Psychiatry Date: 1999-02 Impact factor: 18.112
Authors: E T Isometsä; M M Henriksson; M E Heikkinen; H M Aro; M J Marttunen; K I Kuoppasalmi; J K Lönnqvist Journal: Am J Psychiatry Date: 1996-05 Impact factor: 18.112
Authors: Matthew Jakupcak; Steven Vannoy; Zac Imel; Jessica W Cook; Alan Fontana; Robert Rosenheck; Miles McFall Journal: Depress Anxiety Date: 2010-08-18 Impact factor: 6.505
Authors: Dean P McKenzie; Mark Creamer; Helen L Kelsall; Andrew B Forbes; Jillian F Ikin; Malcolm R Sim; Alexander C McFarlane Journal: Soc Psychiatry Psychiatr Epidemiol Date: 2009-09-10 Impact factor: 4.328
Authors: Subhajit Chakravorty; H Y Katy Siu; Linden Lalley-Chareczko; Gregory K Brown; James C Findley; Michael L Perlis; Michael A Grandner Journal: Prim Care Companion CNS Disord Date: 2015-12-31
Authors: Sadia R Chaudhury; Tanya Singh; Ainsley Burke; Barbara Stanley; J John Mann; Michael Grunebaum; M Elizabeth Sublette; Maria A Oquendo Journal: J Nerv Ment Dis Date: 2016-11 Impact factor: 2.254
Authors: Matthew K Nock; Irving Hwang; Nancy Sampson; Ronald C Kessler; Matthias Angermeyer; Annette Beautrais; Guilherme Borges; Evelyn Bromet; Ronny Bruffaerts; Giovanni de Girolamo; Ron de Graaf; Silvia Florescu; Oye Gureje; Josep Maria Haro; Chiyi Hu; Yueqin Huang; Elie G Karam; Norito Kawakami; Viviane Kovess; Daphna Levinson; Jose Posada-Villa; Rajesh Sagar; Toma Tomov; Maria Carmen Viana; David R Williams Journal: PLoS Med Date: 2009-08-11 Impact factor: 11.069