Vårdvägen 1, SE-112 81 Stockholm, Sweden.
Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, St Görans Hospital, Stockholm, Sweden.
J Clin Psychiatry. 2019 Nov 19;80(6):18m12707. doi: 10.4088/JCP.18m12707.
To compare the predictive accuracy of the Suicide Intent Scale (SIS), the Suicide Assessment Scale (SUAS), the Karolinska Interpersonal Violence Scale (KIVS), and the Columbia-Suicide Severity Rating Scale (C-SSRS) for suicide attempts and suicides within 3 and 12 months of an episode of self-harm.
This prospective multicenter cohort study included patients (N = 804) aged 18-95 years with a recent episode of self-harm assessed in psychiatric emergency settings from April 2012 to April 2016. Suicide attempts and suicides were identified in medical records and in the National Cause of Death Register. Receiver operating characteristic curves were constructed, and accuracy statistics were calculated. A sensitivity of at least 80% combined with a specificity of at least 50% were considered minimally acceptable.
At least 1 suicide attempt was recorded for 216 participants during follow-up, and 19 participants died by suicide. The SUAS and C-SSRS were better than chance in classifying the 114 suicide attempts occurring within the first 3 months; a C-SSRS score ≥ 27 yielded a sensitivity/specificity of 79.8%/51.5% (P < .001). During 1-year follow-up, the SUAS and C-SSRS also performed better than chance, but no cutoff on either instrument gave a sensitivity/specificity of ≥ 80%/≥ 50%. The SIS was the only instrument that could classify suicides correctly. At 3 months, the area under the curve (AUC) was 0.94 (95% CI, 0.89-0.99), and a score ≥ 21 predicted suicide with a sensitivity/specificity of 100%/81.9%, based on only 4 suicides. At 1-year follow-up, the AUC was 0.74 (95% CI, 0.61-0.87), and a score ≥ 17 predicted suicide with a sensitivity/specificity of 72.2%/57.9%.
Instruments that predicted nonfatal repeat suicide attempts did not predict suicide and vice versa. With the possible exception of the prediction of suicide by the SIS in a short time frame, the specificity of these instruments was low, giving them a limited relevance in the prediction of suicidal behaviors.
比较自杀意念量表（SIS）、自杀评估量表（SUAS）、卡罗林斯卡人际暴力量表（KIVS）和哥伦比亚-自杀严重程度评定量表（C-SSRS）在预测自我伤害后 3 个月和 12 个月内自杀企图和自杀的准确性。
这是一项前瞻性多中心队列研究，纳入了 2012 年 4 月至 2016 年 4 月在精神病急诊环境中评估的最近有自我伤害发作的 18-95 岁患者（N=804）。通过病历和国家死因登记处确定自杀企图和自杀。构建了受试者工作特征曲线，并计算了准确性统计数据。灵敏度至少为 80%且特异性至少为 50%被认为是最小可接受的。
在随访期间，有 216 名参与者至少记录了 1 次自杀企图，19 名参与者自杀身亡。SUAS 和 C-SSRS 在分类前 3 个月内发生的 114 次自杀企图方面优于机会水平；C-SSRS 得分≥27 时，灵敏度/特异性为 79.8%/51.5%（P<.001）。在 1 年随访期间，SUAS 和 C-SSRS 也优于机会水平，但在任何一种仪器上都没有确定出灵敏度/特异性≥80%/≥50%的截定点。SIS 是唯一能够正确分类自杀的工具。在 3 个月时，曲线下面积（AUC）为 0.94（95%CI，0.89-0.99），得分≥21 时预测自杀的灵敏度/特异性为 100%/81.9%，仅基于 4 例自杀。在 1 年随访时，AUC 为 0.74（95%CI，0.61-0.87），得分≥17 时预测自杀的灵敏度/特异性为 72.2%/57.9%。
预测非致命性重复自杀企图的工具不能预测自杀，反之亦然。除了 SIS 在短时间内预测自杀的可能性之外，这些工具的特异性较低，这使得它们在预测自杀行为方面的相关性有限。
