Abstract
Alex Pokorny's 1983 prospective study of suicide found that 96.3% of high-risk predictions were false positives, and that more than half of the suicides occurred in the low-risk group and were hence false negatives. All subsequent prospective studies, including the recent US Army Study To Assess Risk and Resilience in Servicemembers (STARRS), have reported similar results. We argue that since risk assessment cannot be a practical basis for interventions aimed at reducing suicide, the alternative is for mental health services to carefully consider what amounts to an adequate standard of care, and to adopt the universal precaution of attempting to provide that to all of our patients.
Highlights
What concerned him more was the overwhelming proportion of false positives, because 96.3% of the patients categorised as high-risk did not commit suicide
Faced with growing concern about suicides among veterans and current serving members of the U.S Armed Forces, the U.S Department of Veterans Affairs and the U.S Department of Defense included the use of risk stratification in clinical practice guidelines.[7]
In other respects the results were eerily familiar, as nearly half of the suicides occurred among the 51 080 low-risk patients, and only 1.3% of the high-risk group died by suicide, leaving an overwhelming number of false positive cases
Summary
Not long after Pokorny, Goldstein et al[3] followed up a cohort of 1906 patients diagnosed with affective disorders and found that none of the 46 suicides occurred among the group, albeit smaller than in Pokorny’s study, defined as being at high risk. Faced with growing concern about suicides among veterans and current serving members of the U.S Armed Forces, the U.S Department of Veterans Affairs and the U.S Department of Defense included the use of risk stratification in clinical practice guidelines.[7] As part of the Study to Assess Risk and Resilience in Servicemembers (STARRS), Kessler and associates examined factors associated with suicide among 53 769 American soldiers in the 12 months after discharge from military psychiatric hospitals,[8] with the benefit of the very detailed longitudinal
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