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The prediction of s...
The prediction of suicide in severe mental illness : development and validation of a clinical prediction rule (OxMIS)
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- Fazel, Seena (författare)
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
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- Wolf, Achim (författare)
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
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- Larsson, Henrik, 1975- (författare)
- Karolinska Institutet,Örebro universitet,Institutionen för medicinska vetenskaper,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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- Mallett, Susan (författare)
- School of Population and Health Sciences, University of Birmingham, Birmingham, UK
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- Fanshawe, Thomas R. (författare)
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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(creator_code:org_t)
- 2019-02-25
- 2019
- Engelska.
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Ingår i: Translational Psychiatry. - : Nature Publishing Group. - 2158-3188. ; 9:1
- Relaterad länk:
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https://doi.org/10.1...
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https://www.nature.c...
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https://urn.kb.se/re...
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https://doi.org/10.1...
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http://kipublication...
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Abstract
Ämnesord
Stäng
- Assessment of suicide risk in individuals with severe mental illness is currently inconsistent, and based on clinical decision-making with or without tools developed for other purposes. We aimed to develop and validate a predictive model for suicide using data from linked population-based registers in individuals with severe mental illness. A national cohort of 75,158 Swedish individuals aged 15-65 with a diagnosis of severe mental illness (schizophrenia-spectrum disorders, and bipolar disorder) with 574,018 clinical patient episodes between 2001 and 2008, split into development (58,771 patients, 494 suicides) and external validation (16,387 patients, 139 suicides) samples. A multivariable derivation model was developed to determine the strength of pre-specified routinely collected socio-demographic and clinical risk factors, and then tested in external validation. We measured discrimination and calibration for prediction of suicide at 1 year using specified risk cut-offs. A 17-item clinical risk prediction model for suicide was developed and showed moderately good measures of discrimination (c-index 0.71) and calibration. For risk of suicide at 1 year, using a pre-specified 1% cut-off, sensitivity was 55% (95% confidence interval [CI] 47-63%) and specificity was 75% (95% CI 74-75%). Positive and negative predictive values were 2% and 99%, respectively. The model was used to generate a simple freely available web-based probability-based risk calculator (Oxford Mental Illness and Suicide tool or OxMIS) without categorical cut-offs. A scalable prediction score for suicide in individuals with severe mental illness is feasible. If validated in other samples and linked to effective interventions, using a probability score may assist clinical decision-making.
Ämnesord
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Psykiatri (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Psychiatry (hsv//eng)
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