McMillan Dean, Gilbody Simon, Beresford Emma, Neilly Liz
Academic Unit of Psychiatry and Behavioural Sciences, University of Leeds, UK.
Psychol Med. 2007 Jun;37(6):769-78. doi: 10.1017/S0033291706009664. Epub 2007 Jan 4.
Hopelessness is considered a pre-eminent risk factor for suicide and non-fatal self-harm. We aimed to quantify the ability of the Beck Hopelessness Scale (BHS) to predict these two outcomes.
Medline, Embase, PsycINFO and Cinahl were searched to January 2006. We included cohort studies in which the BHS was applied and patients were followed-up to establish subsequent suicide or non-fatal self-harm. Four studies provided usable data on suicide, and six studies provided data on non-fatal self-harm. Summary sensitivity, specificity, likelihood ratios and diagnostic odds ratios (DORs) were calculated for each study. Random effects meta-analytic pooling across studies at the standard cut-off point (> or =9) was undertaken and summary receiver operating characteristic (ROC) curves constructed.
For suicide, pooled sensitivity was 0.80 [95% confidence interval (CI) 0.68-0.90], pooled specificity was 0.42 (95% CI 0.41-0.44), and the pooled DOR was 3.39 (95% CI 1.29-8.88). For non-fatal self-harm, pooled sensitivity was 0.78 (95% CI 0.74-0.82), pooled specificity was 0.42 (95% CI 0.38-0.45), and the pooled DOR was 2.27 (95% CI 1.53-3.37).
The standard cut-off point on the BHS identifies a high-risk group for potential suicide, but the magnitude of the risk is lower than previously reported estimates. The standard cut-off point is also capable of identifying those who are at risk of future self-harm, but the low specificity rate means it is unlikely to be of use in targeting treatment designed to lower the rate of repetition.
绝望被认为是自杀和非致命性自我伤害的一个突出风险因素。我们旨在量化贝克绝望量表（BHS）预测这两种结果的能力。
检索了截至2006年1月的Medline、Embase、PsycINFO和Cinahl数据库。我们纳入了应用了BHS且对患者进行随访以确定随后是否发生自杀或非致命性自我伤害的队列研究。四项研究提供了关于自杀的可用数据，六项研究提供了关于非致命性自我伤害的数据。计算了每项研究的汇总敏感性、特异性、似然比和诊断比值比（DOR）。在标准临界值（≥9）时对各项研究进行随机效应荟萃分析合并，并构建汇总受试者工作特征（ROC）曲线。
对于自杀，汇总敏感性为0.80[95%置信区间（CI）0.68 - 0.90]，汇总特异性为0.42（95%CI 0.41 - 0.44），汇总DOR为3.39（95%CI 1.29 - 8.88）。对于非致命性自我伤害，汇总敏感性为0.78（95%CI 0.74 - 0.82），汇总特异性为0.42（95%CI 0.38 - 0.45），汇总DOR为2.27（95%CI 1.53 - 3.37）。
BHS的标准临界值可识别出潜在自杀的高危人群，但风险程度低于先前报道的估计值。该标准临界值也能够识别出未来有自我伤害风险的人群，但低特异性意味着它不太可能用于针对降低重复率的治疗。
