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The expression of suicidal ideation is considered to be an important warning sign for suicide. However, the predictive properties of suicidal ideation as a test of later suicide are unclear.
To assess the strength of the association between suicidal ideation and later suicide measured by odds ratio (OR), sensitivity, specificity and positive predictive value (PPV).
We located English-language studies indexed in PubMed that reported the expression or non-expression of suicidal ideation among people who later died by suicide or did not. A random effects meta-analysis was used to assess the pooled OR, sensitivity, specificity and PPV of suicidal ideation for later suicide among groups of people from psychiatric and non-psychiatric settings.
There was a moderately strong but highly heterogeneous association between suicidal ideation and later suicide (n = 71, OR = 3.41, 95% CI 2.59–4.49, 95% prediction interval 0.42–28.1, I2 = 89.4, Q-value = 661, d.f.(Q) = 70, P ≤0.001). Studies conducted in primary care and other non-psychiatric settings had similar pooled odds to studies of current and former psychiatric patients (OR = 3.86 v. OR = 3.23, P = 0.7). The pooled sensitivity of suicidal ideation for later suicide was 41% (95% CI 35–48) and the pooled specificity was 86% (95% CI 76–92), with high between-study heterogeneity. Studies of suicidal ideation expressed by current and former psychiatric patients had a significantly higher pooled sensitivity (46% v. 22%) and lower pooled specificity (81% v. 96%) than studies conducted in non-psychiatric settings. The PPV among non-psychiatric cohorts (0.3%, 95% CI 0.1%–0.5%) was significantly lower (Q-value = 35.6, P < 0.001) than among psychiatric samples (3.9%, 95% CI 2.2–6.6).
Estimates of the extent of the association between suicidal ideation and later suicide are limited by unexplained between-study heterogeneity. The utility of suicidal ideation as a test for later suicide is limited by a modest sensitivity and low PPV.
M.M.L. and C.J.R. have provided expert evidence in civil, criminal and coronial matters. I.B.H. has been a Commissioner in Australia's National Mental Health Commission since 2012. He is the Co-Director, Health and Policy at the Brain and Mind Centre (BMC) University of Sydney. The BMC operates an early-intervention youth services at Camperdown under contract to Headspace. I.B.H. has previously led community-based and pharmaceutical industry-supported (Wyeth, Eli Lily, Servier, Pfizer, AstraZeneca) projects focused on the identification and better management of anxiety and depression. He is a Board Member of Psychosis Australia Trust and a member of Veterans Mental Health Clinical Reference group. He was a member of the Medical Advisory Panel for Medibank Private until October 2017. He is the Chief Scientific Advisor to, and an equity shareholder in, InnoWell. InnoWell has been formed by the University of Sydney and PricewaterhouseCoopers to administer the $30 M Australian Government Funded Project Synergy. Project Synergy is a 3-year programme for the transformation of mental health services through the use of innovative technologies.
Recent qualitative research suggests that changes to the way eligibility for welfare payments is determined in the UK may be detrimental to claimants with mental illnesses. No large-scale analysis has been undertaken to date.
To examine differences between claimants with psychiatric conditions compared with non-psychiatric conditions in the number of claims disallowed following a personal independence payment (PIP) eligibility assessment for existing disability living allowance (DLA) claimants.
Administrative data on DLA claimants with psychiatric conditions transferring to PIP between 2013 and 2016 was compared with claimants with non-psychiatric conditions to explore differences in the number of claims disallowed following an eligibility assessment.
Claimants with a mental illness were 2.40 (95% CI 2.36–2.44) times more likely to have their existing DLA entitlement removed following a PIP eligibility assessment than claimants with musculoskeletal conditions, neurological conditions and diabetes.
PIP eligibility assessment outcomes show marked differences by health condition, raising questions as to whether the process is equitable.
Biomedical research from low- and middle-income countries (LMICs) is poorly represented in Western European and North American psychiatric journals.
To test the feasibility of trialling a capacity-building intervention to improve LMIC papers' representation in biomedical journals.
We designed an enhanced peer-review intervention delivered to LMIC corresponding/first authors of papers rejected by the British Journal of Psychiatry. We conducted a feasibility study, inviting consenting authors to be randomised to intervention versus none, measuring recruitment and retention rates, outcome completion and author/reviewer-rated acceptability.
Of the 26/121 consenting to participate, 12 were randomised to the intervention and 14 to the control arms. Outcome completion was 100% but qualitative feedback from authors/reviewers was mixed, with attrition from 5/12 (42%) of intervention reviewers.
Low interest among eligible authors and variable participation of expert reviewers suggested low feasibility of a full trial and a need for intervention redesign.
Declaration of interest
A.P., P.T. and M.Y. are British Journal of Psychiatry editorial board members. During this study P.T. was British Journal of Psychiatry Editor, A.P. was a trainee editor and A.H. was an editorial assistant.