Volume 199 - Issue 8
Suicide risk assessment: where are we now?
Authors: Michael S Gordon and Glenn A Melvin
Med J Aust 2013; 199 (8): 534. || doi: 10.5694/mja13.10761
Published online: 21 October 2013
Published online: 21 October 2013
Can assessing risk factors for suicide attempts help in predicting suicide risk?
To the Editor: We applaud Ryan and Large for their timely editorial reviewing suicide risk factors.1 We agree that, with current knowledge, we do not know how to combine risk factors to produce a reliable predictor of suicide risk in the short to medium term.
However, we note that many risk factors for suicide are also risk factors for suicide attempts.2 For adolescents, attempts occur at a rate of between 400 and 3000 for each suicide.3 Therefore, detection of suicide risk factors also contributes to identifying those who are at risk of attempting suicide, something not discussed by Ryan and Large. Suicide attempts lead to medical morbidity and family suffering and are a considerable burden on emergency departments.4
We find Ryan and Large’s advice that, “here and now, clinicians should not be conducting ‘comprehensive suicide risk assessments’” problematic. They do not provide a meaningful alternative.
We are concerned that medical practitioners who read the editorial will abandon asking about suicide altogether. We are unclear what the authors define as constituting “psychological crisis” and wonder how feasible it would be for general practitioners to make crisis plans with possibly a large number of their patients. We are also interested in the opinion of medical indemnity organisations regarding the authors’ advice to not conduct comprehensive risk assessments, in the event that a patient who presents with suicidal thinking comes to any harm.
Competing interests
No relevant disclosures.
References
- Ryan CJ, Large MM. Suicide risk assessment: where are we now [editorial]? Med J Aust 2013; 198: 462-463.
- Beautrais AL. Risk factors for suicide and attempted suicide among young people. Aust N Z J Psychiatry 2000; 34: 420-436. 0_i1142869
- Mann JJ, Emslie G, Baldessarini RJ, et al. ACNP Task Force report on SSRIs and suicidal behavior in youth. Neuropsychopharmacology 2006; 31: 473-492. 0_i1142873
- Larkin GL, Smith RP, Beautrais AL. Trends in US emergency department visits for suicide attempts, 1992-2001. Crisis 2008; 29: 73-80. 0_i1142876