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Psychol Med. 2007 Jun;37(6):769-78. Epub 2007 Jan 4.

Can we predict suicide and non-fatal self-harm with the Beck Hopelessness Scale? A meta-analysis.

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  • 1Academic Unit of Psychiatry and Behavioural Sciences, University of Leeds, UK. d.mcmillan@leeds.ac.uk

Abstract

BACKGROUND:

Hopelessness is considered a pre-eminent risk factor for suicide and non-fatal self-harm. We aimed to quantify the ability of the Beck Hopelessness Scale (BHS) to predict these two outcomes.

METHOD:

Medline, Embase, PsycINFO and Cinahl were searched to January 2006. We included cohort studies in which the BHS was applied and patients were followed-up to establish subsequent suicide or non-fatal self-harm. Four studies provided usable data on suicide, and six studies provided data on non-fatal self-harm. Summary sensitivity, specificity, likelihood ratios and diagnostic odds ratios (DORs) were calculated for each study. Random effects meta-analytic pooling across studies at the standard cut-off point (> or =9) was undertaken and summary receiver operating characteristic (ROC) curves constructed.

RESULTS:

For suicide, pooled sensitivity was 0.80 [95% confidence interval (CI) 0.68-0.90], pooled specificity was 0.42 (95% CI 0.41-0.44), and the pooled DOR was 3.39 (95% CI 1.29-8.88). For non-fatal self-harm, pooled sensitivity was 0.78 (95% CI 0.74-0.82), pooled specificity was 0.42 (95% CI 0.38-0.45), and the pooled DOR was 2.27 (95% CI 1.53-3.37).

CONCLUSION:

The standard cut-off point on the BHS identifies a high-risk group for potential suicide, but the magnitude of the risk is lower than previously reported estimates. The standard cut-off point is also capable of identifying those who are at risk of future self-harm, but the low specificity rate means it is unlikely to be of use in targeting treatment designed to lower the rate of repetition.

PMID:
17202001
[PubMed - indexed for MEDLINE]
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