Self-injurious thoughts and behaviors as risk factors for future suicide ideation, attempts, and death: a meta-analysis of longitudinal studies

By Jessica D. Ribeiro, Joseph C. Franklin, K. Fox, Kate H Bentley, Evan M. Kleiman, B. Chang, Matthew K. Nock. Psychological Medicine, 2015

1,058 citations recorded by the source corpus.

Background A history of self-injurious thoughts and behaviors (SITBs) is consistently cited as one of the strongest predictors of future suicidal behavior. However, stark discrepancies in the literature raise questions about the true magnitude of these associations. The objective of this study is to examine the magnitude and clinical utility of the associations between SITBs and subsequent suicide ideation, attempts, and death. Method We searched PubMed, PsycInfo, and Google Scholar for papers published through December 2014. Inclusion required that studies include at least one longitudinal analysis predicting suicide ideation, attempts, or death using any SITB variable. We identified 2179 longitudinal studies; 172 met inclusion criteria. Results The most common outcome was suicide attempt (47.80%), followed by death (40.50%) and ideation (11.60%). Median follow-up was 52 months (mean = 82.52, s.d. = 102.29). Overall prediction was weak, with weighted mean odds ratios (ORs) of 2.07 [95% confidence interval (CI) 1.76–2.43] for ideation, 2.14 (95% CI 2.00–2.30) for attempts, and 1.54 (95% CI 1.39–1.71) for death. Adjusting for publication bias further reduced estimates. Diagnostic accuracy analyses indicated acceptable specificity (86–87%) and poor sensitivity (10–26%), with areas under the curve marginally above chance (0.60–0.62). Most risk factors generated OR estimates of <2.0 and no risk factor exceeded 4.5. Effects were consistent regardless of sample severity, sample age groups, or follow-up length. Conclusions Prior SITBs confer risk for later suicidal thoughts and behaviors. However, they only provide a marginal improvement in diagnostic accuracy above chance. Addressing gaps in study design, assessment, and underlying mechanisms may prove useful in improving prediction and prevention of suicidal thoughts and behaviors.

Subfields: Clinical Psychology

View Paper: https://www.semanticscholar.org/paper/82a087a40a7feb629c23e5b9dd348af3df018616

How researchers see this paper

The researchers whose trusted networks rank it highest, strongest advocate first. Every researcher gets a different order.

In Clinical Psychology

Citations in the corpus

Examination of Real-Time Fluctuations in Suicidal Ideation and Its Risk Factors: Results From Two Ecological Momentary Assessment Studies (2017, background): “…that these risk factors, long believed to be fairly stable over short periods of time (i.e., a meta-analytic review found that the median time between assessments of suicidal ideation was 24 months; Ribeiro et al., 2016), actually vary quite dramatically over short time periods of hours and days.”
Predicting Risk of Suicide Attempts Over Time Through Machine Learning (2017, background): “Second, given the importance of prior suicidal behaviors in future suicidal behavior (see Ribeiro et al., 2016a), one possibility is that the present approach would be more effective for individuals with a documented history of prior suicidal behaviors.”
A meta-analysis of the prevalence of different functions of non-suicidal self-injury. (2018, background): “later suicidal behaviour (OR = 4.27; Ribeiro et al., 2016) despite protection from suicide being one reported function of the behaviour (Klonsky, 2007b).”