Thursday, April 20, 2023

Tool Helps Predict Suicide Risk Among People With Serious Mental Illness

The Oxford Mental Illness and Suicide tool (OxMIS) can accurately predict those with serious mental illness (SMI) who are at greatest risk of suicide, according to a study published this week in Translational Psychiatry.

“With further research on feasibility and work considering how to link risk scores to interventions, OxMIS could assist mental health services in reducing suicide rates in people with SMI,” wrote Amir Sariaslan, Ph.D., of the University of Oxford and colleagues.

OxMIS, is a brief, scalable assessment tool that uses 17 risk factors to determine suicide risk, including:

  • Sociodemographic traits (such as sex, age, and educational attainment).
  • Antisocial and suicidal traits (such as previous violent crime and self-harm).
  • Familial traits (such as parent history of substance use or suicide).
  • Clinical traits (such as recent inpatient care and comorbid depression).

OxMIS was initially tested and validated in a cohort of more than 75,000 individuals diagnosed with SMI in Sweden. In this study, the researchers looked to validate the tool in a second, different sample of patients.

Sariaslan and colleagues used population-based data from Finland, including the Care Register for Health Care, to identify all individuals aged 15 to 65 who were diagnosed with an SMI between 1996 and 2017. The authors identified a cohort of 137,112 individuals who had over 5 million recorded episodes of schizophrenia spectrum disorder or bipolar disorder. They randomly selected one episode per person to be the index episode, as OxMIS is intended to be used at a single time point. The authors then used OxMIS to calculate each individual’s 12-month suicide risk. Finally, the authors used Finland’s Causes of Death Register to identify those participants who died by suicide during the follow-up period.

In the 12 months following the index episodes, 1,475 participants died by suicide (1.1%). OxMIS was able to discriminate suicide risk with an area under the curve of 0.70. This means that in 70% of the instances when the authors randomly selected two participants, one who died by suicide and one who did not, OxMIS gave the person who died by suicide a higher predictive suicide risk score, the authors noted.

Prognostic models and tools are inconsistently used in mental health care, in part because these tools are rarely tested on cohorts of patients outside of the populations in which they were developed, Sariaslan and colleagues wrote. “Such validation is a necessary step on the path to implementation alongside work on feasibility, acceptability, and clinical impact. In the suicide field, this is not different—few models have been externally validated despite their clinical use in some settings.”

For related information, see the Psychiatric Services article “Universal Suicide Screening Is Feasible and Necessary to Reduce Suicide.”

(Image: iStock/Jay Yuno)

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