OBJECTIVES: Structured professional judgement is now the most widely accepted approach to clinical risk assessment and risk management. The Suicide Risk Assessment and Management Manual (S-RAMM) is a new structured professional judgement tool closely modelled on the HCR-20. This is the first prospective validation study for this instrument. METHODS: Two post-membership registrars jointly interviewed 81 of 83 current inpatients to rate the S-RAMM. Two assistant psychologists independently rated the HCR-20, GAF and PANSS. All incidents of self-harm, attempted suicide, suicide and violence to others were collated from hospital reporting of critical incidents over the next six months supplemented by examination of other records. RESULTS: For combined self-harm and suicide outcomes, the S-RAMM total score using the receiver operating characteristic had an area under the curve AUC=0.89, (95% CI 0.79 to 0.99). The S-RAMM performed as well for the prediction of self-harm and suicide as the HCR-20 did for violence, and better than measures of mental state (PANSS total score) and global function (GAF). CONCLUSIONS: The S-RAMM has better than minimum acceptable characteristics for use as a clinical or research tool for suicide risk assessment, and performs almost as well as the HCR-20 does for violence. Further prospective studies are now required, in other populations.
OBJECTIVES: Structured professional judgement is now the most widely accepted approach to clinical risk assessment and risk management. The Suicide Risk Assessment and Management Manual (S-RAMM) is a new structured professional judgement tool closely modelled on the HCR-20. This is the first prospective validation study for this instrument. METHODS: Two post-membership registrars jointly interviewed 81 of 83 current inpatients to rate the S-RAMM. Two assistant psychologists independently rated the HCR-20, GAF and PANSS. All incidents of self-harm, attempted suicide, suicide and violence to others were collated from hospital reporting of critical incidents over the next six months supplemented by examination of other records. RESULTS: For combined self-harm and suicide outcomes, the S-RAMM total score using the receiver operating characteristic had an area under the curve AUC=0.89, (95% CI 0.79 to 0.99). The S-RAMM performed as well for the prediction of self-harm and suicide as the HCR-20 did for violence, and better than measures of mental state (PANSS total score) and global function (GAF). CONCLUSIONS: The S-RAMM has better than minimum acceptable characteristics for use as a clinical or research tool for suicide risk assessment, and performs almost as well as the HCR-20 does for violence. Further prospective studies are now required, in other populations.
Authors: Mary Davoren; Sarah O'Dwyer; Zareena Abidin; Leena Naughton; Olivia Gibbons; Elaine Doyle; Kim McDonnell; Stephen Monks; Harry G Kennedy Journal: BMC Psychiatry Date: 2012-07-13 Impact factor: 3.630
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Authors: Nicola S Gray; Ann John; Aimee McKinnon; Stephanie Raybould; James Knowles; Robert J Snowden Journal: Front Psychiatry Date: 2021-05-17 Impact factor: 4.157