Risk factors for suicide in adults : systematic review and meta-analysis of psychological autopsy studies

Question: Effective prevention of suicide requires a comprehensive understanding of risk factors. Study selection and analysis: Five databases were systematically searched to identify psychological autopsy studies (published up to February 2022) that reported on risk factors for suicide mortality among adults in the general population. Effect sizes were pooled as odds ratios (ORs) using random-effects models for each risk factor examined in at least three independent samples. Findings: A total of 37 case–control studies from 23 countries were included, providing data on 40 risk factors in 5633 cases and 7101 controls. The magnitude of effect sizes varied substantially both between and within risk factor domains. Clinical factors had the strongest associations with suicide, including any mental disorder (OR=13.1, 95% CI 9.9 to 17.4) and a history of self-harm (OR=10.1, 95% CI 6.6 to 15.6). By comparison, effect sizes were smaller for other domains relating to sociodemographic status, family history, and adverse life events (OR range 2–5). Conclusions: A wide range of predisposing and precipitating factors are associated with suicide among adults in the general population, but with clear differences in their relative strength. PROSPERO registration number: CRD42021232878

The Structured Assessment of Protective Factors for violence risk (SAPROF): A Meta-analysis of its reliability and predictive validity

Although the inclusion of protective factors in risk assessment is believed to improve prediction, most risk assessment tools emphasize risk factors. One tool that attempts to balance risk factors with protective factors is the Structured Assessment of Protective Factors for Violence Risk (SAPROF). The SAPROF focuses exclusively on protective factors and is used in conjunction with a structured risk assessment tool. It has received increasing attention from both researchers and forensic mental health practitioners in recent years. To assess its psychometric performance, we conducted a meta-analysis of validation studies using random effects models. Our final sample included 22 studies with 3,216 subjects from 12 countries. Overall, the SAPROF showed good interrater reliability and moderate to good predictive performance for desistance from violence in terms of institutional misconduct and community recidivism. The instrument also exhibited incremental validity when used in conjunction with the Historical Clinical Risk Management-20 (HCR-20). Despite these promising results, this meta-analysis also uncovered several shortcomings in current research on the SAPROF. Studies did not report data on calibration, thus failing to capture the full picture of the SAPROF’s predictive performance. Moreover, risk of bias across studies was high and findings are mostly restricted to male samples. Directions for future research and recommendations for the use of the SAPROF are offered