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Prediction of suicide attempts in a prospective cohort study with a nationally representative sample of the US population

Published online by Cambridge University Press:  14 January 2021

Cristiane dos Santos Machado Open the ORCID record for Cristiane dos Santos Machado [Opens in a new window] ,
Pedro L. Ballester ,
Bo Cao ,
Benson Mwangi ,
Marco Antonio Caldieraro ,
Flávio Kapczinski  and
Ives Cavalcante Passos
Cristiane dos Santos Machado
Affiliation:
Laboratory of Molecular Psychiatry, Centro de Pesquisa Experimental (CPE) e Centro de Pesquisa Clínica (CPC), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil Department of Psychiatry, Faculty of Medicine, Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
Pedro L. Ballester
Affiliation:
Neuroscience Graduate Program, McMaster University, Hamilton, ON, Canada
Bo Cao
Affiliation:
Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
Benson Mwangi
Affiliation:
Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, Texas, USA
Marco Antonio Caldieraro
Affiliation:
Laboratory of Molecular Psychiatry, Centro de Pesquisa Experimental (CPE) e Centro de Pesquisa Clínica (CPC), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil Department of Psychiatry, Faculty of Medicine, Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
Flávio Kapczinski
Affiliation:
Laboratory of Molecular Psychiatry, Centro de Pesquisa Experimental (CPE) e Centro de Pesquisa Clínica (CPC), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil Department of Psychiatry, Faculty of Medicine, Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil Department of Psychiatry and Behavioural Neurosciences, McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
Ives Cavalcante Passos*
Affiliation:
Laboratory of Molecular Psychiatry, Centro de Pesquisa Experimental (CPE) e Centro de Pesquisa Clínica (CPC), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil Department of Psychiatry, Faculty of Medicine, Graduate Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
*
Author for correspondence: Ives Cavalcante Passos, E-mail: ivescp1@gmail.com
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Abstract

Background

There is still little knowledge of objective suicide risk stratification.

Methods

This study aims to develop models using machine-learning approaches to predict suicide attempt (1) among survey participants in a nationally representative sample and (2) among participants with lifetime major depressive episodes. We used a cohort called the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) that was conducted in two waves and included a nationally representative sample of the adult population in the United States. Wave 1 involved 43 093 respondents and wave 2 involved 34 653 completed face-to-face reinterviews with wave 1 participants. Predictor variables included clinical, stressful life events, and sociodemographic variables from wave 1; outcome included suicide attempt between wave 1 and wave 2.

Results

The model built with elastic net regularization distinguished individuals who had attempted suicide from those who had not with an area under the ROC curve (AUC) of 0.89, balanced accuracy 81.86%, specificity 89.22%, and sensitivity 74.51% for the general population. For participants with lifetime major depressive episodes, AUC was 0.89, balanced accuracy 81.64%, specificity 85.86%, and sensitivity 77.42%. The most important predictor variables were a diagnosis of borderline personality disorder, post-traumatic stress disorder, and being of Asian descent for the model in all participants; and previous suicide attempt, borderline personality disorder, and overnight stay in hospital because of depressive symptoms for the model in participants with lifetime major depressive episodes. Random forest and artificial neural networks had similar performance.

Conclusions

Risk for suicide attempt can be estimated with high accuracy.

Keywords

Suicidemachine learningpredictionNESARCdepression
Type
Original Article
Information
Psychological Medicine , Volume 52 , Issue 14 , October 2022 , pp. 2985 - 2996
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Copyright
Copyright © The Author(s) 2021. Published by Cambridge University Press

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References

Al-Sayegh, H., Lowry, J., Polur, R. N., Hines, R. B., Liu, F., & Zhang, J. (2015). Suicide history and mortality: A follow-up of a national cohort in the United States. Archives of Suicide Research, 19(1), 35–47. doi: 10.1080/13811118.2013.855154.CrossRefGoogle ScholarPubMed
Almeida, O. P., Draper, B., Snowdon, J., Lautenschlager, N. T., Pirkis, J., Byrne, G., … Pfaff, J. J. (2012). Factors associated with suicidal thoughts in a large community study of older adults. British Journal of Psychiatry, 201(6), 466–472. doi: 10.1192/bjp.bp.112.110130.CrossRefGoogle Scholar
American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (Fifth Edition). Arlington, VA: American Psychiatric Association.Google Scholar
Arsenault-Lapierre, G., Kim, C., & Turecki, G. (2004). Psychiatric diagnoses in 3275 suicides: A meta-analysis. BMC Psychiatry, 4, 1–11. doi: 10.1186/1471-244X-4-37.CrossRefGoogle ScholarPubMed
Belsher, B. E., Smolenski, D. J., Pruitt, L. D., Bush, N. E., Beech, E. H., Workman, D. E., … Skopp, N. A. (2019). Prediction models for suicide attempts and deaths: A systematic review and simulation. JAMA Psychiatry, 76(6), 642–651. doi: 10.1001/jamapsychiatry.2019.0174.CrossRefGoogle ScholarPubMed
Borczyskowski, A., Hjern, A., Lindblad, F., & Vinnerljung, B. (2006). Suicidal behaviour in national and international adult adoptees: A Swedish cohort study. Social Psychiatry and Psychiatric Epidemiology, 41(2), 95–102. doi: 10.1007/s00127-005-0974-2.CrossRefGoogle Scholar
Borges, G., Angst, J., Nock, M. K., Ruscio, A. M., Walters, E. E., & Kessler, R. C. (2007). Risk factors for twelve-month suicide attempts in the National Comorbidity Survey Replication (NCS-R). Psychological Medicine, 36(12), 1747–1757. doi: 10.1017/S0033291706008786.CrossRefGoogle Scholar
Borges, G., Nock, M. K., Abad, J. M. H., Sampson, N. A., Alonso, J., Helena, L., … Williams, D. R. (2010). Twelve month prevalence of and risk factors for suicide attempts in the WHO world mental health surveys. The Journal of Clinical Psychiatry, 71(12), 1617–1628. doi: 10.4088/JCP.08m04967blu.CrossRefGoogle Scholar
Breiman, L. (2001). Random forests. Machine Learning, 45(1), 5–32. doi: 10.1023/A:1010933404324.CrossRefGoogle Scholar
Carroll, R., Metcalfe, C., & Gunnell, D. (2014). Hospital presenting self-harm and risk of fatal and non- fatal repetition: Systematic review and meta-analysis. PLoS ONE, 9(2), e89944. doi: 10.1371/journal.pone.0089944.CrossRefGoogle ScholarPubMed
Choi, S. B., Lee, W., Yoon, J. H., Won, J. U., & Kim, D. W. (2018). Ten-year prediction of suicide death using Cox regression and machine learning in a nationwide retrospective cohort study in South Korea. Journal of Affective Disorders, 231, 8–14. doi: 10.1016/j.jad.2018.01.019.CrossRefGoogle Scholar
Cipriani, A., Hawton, K., Stockton, S., & Geddes, J. R. (2013). Lithium in the prevention of suicide in mood disorders: Updated systematic review and meta-analysis. BMJ, 346, f3646. doi: 10.1136/bmj.f3646.CrossRefGoogle ScholarPubMed
Cross, S. S., Harrison, R. F., & Kennedy, R. L. (1995). Introduction to neural networks. The Lancet, 346(8982), 1075–1079. doi: 10.1016/S0140-6736(95)91746-2.CrossRefGoogle ScholarPubMed
Forte, A., Trobia, F., Gualtieri, F., Lamis, D. A., Cardamone, G., Giallonardo, V., … Pompili, M. (2018). Suicide risk among immigrants and ethnic minorities: A literature overview. International Journal of Environmental Research and Public Health, 15(7), 1438. doi: 10.3390/ijerph15071438.CrossRefGoogle ScholarPubMed
Galfalvy, H. C., Oquendo, M. A., & Mann, J. J. (2008). Evaluation of clinical prognostic models for suicide attempts after a major depressive episode. Acta Psychiatrica Scandinavica, 117(4), 244–252. doi: 10.1111/j.1600-0447.2008.01162.x.CrossRefGoogle ScholarPubMed
Gevrey, M., Dimopoulos, I., & Lek, S. (2003). Review and comparison of methods to study the contribution of variables in artificial neural network models. Ecological Modelling, 160(3), 249–264. doi: 10.1016/S0304-3800(02)00257-0.CrossRefGoogle Scholar
Hasin, D. S., & Grant, B. F. (2015). The national epidemiologic survey on alcohol and related conditions (NESARC) waves 1 and 2: Review and summary of findings. Social Psychiatry and Psychiatric Epidemiology, 50(11), 1609–1640. doi: 10.1007/s00127-015-1088-0.CrossRefGoogle ScholarPubMed
Hedegaard, H., Curtin, S. C., & Warner, M. (2018). Suicide Mortality in the United States, 1999–2017. NCHS data brief, (330), 1–8. Retrieved from https://www.cdc.gov/nchs/data/databriefs/db330_tables-508.pdf#2.Google Scholar
Heikkinen, M., Aro, H., & Lönnqvist, J. (1992). Recent life events and their role in suicide as seen by the spouses. Acta Psychiatrica Scandinavica, 86(6), 489–494. doi: 10.1111/j.1600-0447.1992.tb03303.x.CrossRefGoogle ScholarPubMed
Hoertel, N., Franco, S., Wall, M. M., Oquendo, M. A., Kerridge, B. T., Limosin, F., & Blanco, C. (2015). Mental disorders and risk of suicide attempt: A national prospective study. Molecular Psychiatry, 20(6), 718–726. doi: 10.1038/mp.2015.19.CrossRefGoogle ScholarPubMed
Holma, K. M., Melartin, T. K., Haukka, J., Holma, I. A. K., Sokero, T. P., & Isometsä, E. T. (2010). Incidence and predictors of suicide attempts in DSM-IV major depressive disorder: A five-year prospective study. American Journal of Psychiatry, 167(7), 801–808. doi: 10.1176/appi.ajp.2010.09050627.CrossRefGoogle ScholarPubMed
Isometsä, E. (2014). Suicidal behaviour in mood disorders – who, when, and why? Canadian Journal of Psychiatry, 59(3), 120–130. doi: 10.1177/070674371405900303.CrossRefGoogle ScholarPubMed
Johnston, A. K., Pirkis, J. E., & Burgess, P. M. (2009). Suicidal thoughts and behaviours among Australian adults: Findings from the 2007 national survey of mental health and wellbeing. Australian and New Zealand Journal of Psychiatry, 43(7), 635–643. doi: 10.1080/00048670902970874.CrossRefGoogle ScholarPubMed
Jokinen, J., Talbäck, M., Feychting, M., Ahlbom, A., & Ljung, R. (2018). Life expectancy after the first suicide attempt. Acta Psychiatrica Scandinavica, 137(4), 287–295. doi: 10.1111/acps.12842.CrossRefGoogle ScholarPubMed
Kessler, R. C., Warner, C. H., Ivany, C., Petukhova, M. V., Rose, S., Bromet, E. J., … Ursano, R. J. (2015). Predicting suicides after psychiatric hospitalization in US army soldiers: The Army Study to Assess Risk and Resilience in Service members (Army STARRS). JAMA Psychiatry, 72(1), 49–57. doi: 10.1001/jamapsychiatry.2014.1754.CrossRefGoogle Scholar
Keyes, M. A., Malone, S. M., Sharma, A., Iacono, W. G., & McGue, M. (2013). Risk of suicide attempt in adopted and nonadopted offspring. Pediatrics, 132(4), 639–646. doi: 10.1542/peds.2012-3251.CrossRefGoogle ScholarPubMed
Kuhn, M. (2008). Caret package. Journal of Statistical Software, 28(5), 1–26. Retrieved from http://www.jstatsoft.org/v28/i05/paper.Google Scholar
Leichsenring, F., Leibing, E., Kruse, J., New, A. S., & Leweke, F. (2011). Borderline personality disorder. The Lancet, 377, 74–84. doi: 10.1016/S0140-6736(10)61422-5.CrossRefGoogle ScholarPubMed
Morey, L. C., Lowmaster, S. E., & Hopwood, C. J. (2010). A pilot study of manual-assisted cognitive therapy with a therapeutic assessment augmentation for borderline personality disorder. Psychiatry Research, 178(3), 531–535. doi: 10.1016/j.psychres.2010.04.055.CrossRefGoogle ScholarPubMed
National Institute on Alcohol Abuse and Alcoholism. (2006). National epidemiologic survey on alcohol and related conditions (NESARC). Alcohol Alert, 70(1), 1–6. Retrieved from http://www.niaaa.nih.gov.Google Scholar
Nock, M. K., Borges, G., Bromet, E. J., Alonso, J., Angermeyer, M., Beautrais, A., … Williams, D. (2008). Cross-national prevalence and risk factors for suicidal ideation, plans and attempts. British Journal of Psychiatry, 192(2), 98–105. doi: 10.1192/bjp.bp.107.040113.CrossRefGoogle ScholarPubMed
Nock, M. K., Hwang, I., Sampson, N. A., & Kessler, R. C. (2010). Mental disorders, comorbidity and suicidal behavior: Results from the national comorbidity survey replication. Molecular Psychiatry, 15(8), 868–876. doi: 10.1038/mp.2009.29.Mental.CrossRefGoogle ScholarPubMed
Oquendo, M. A., Galfalvy, H., Russo, S., Ellis, S. P., Grunebaum, M. F., Burke, A., & Mann, J. J. (2004). Prospective study of clinical predictors of suicidal acts after a major depressive episode in patients with major depressive or bipolar disorder. American Journal of Psychiatry, 161(8), 1433–1441. doi: 10.1176/appi.ajp.161.8.1433.CrossRefGoogle ScholarPubMed
Oquendo, M. A., Perez-Rodriguez, M. M., Poh, E., Sullivan, G., Burke, A. K., Sublette, M. E., … Galfalvy, H. (2014). Life events: A complex role in the timing of suicidal behavior among depressed patients. Molecular Psychiatry, 19(8), 902–909. doi: 10.1038/mp.2013.128.CrossRefGoogle ScholarPubMed
Panagioti, M., Gooding, P. A., & Tarrier, N. (2012). A meta-analysis of the association between posttraumatic stress disorder and suicidality: The role of comorbid depression. Comprehensive Psychiatry, 53(7), 915–930. doi: j.comppsych.2012.02.009.CrossRefGoogle ScholarPubMed
Passos, I. C., & Ballester, P. (2019). Positive predictive values and potential success of suicide prediction models. JAMA Psychiatry, 76(8), 869. doi: 10.1001/jamapsychiatry.2019.1507.CrossRefGoogle ScholarPubMed
Passos, I. C., Ballester, P. L., Barros, R. C., Librenza-Garcia, D., Mwangi, B., Birmaher, B., … Kapczinski, F. (2019). Machine learning and big data analytics in bipolar disorder: A position paper from the International Society For Bipolar Disorders Big data task force. Bipolar Disorders, 21(7), 582–594. doi: 10.1111/bdi.12828.CrossRefGoogle ScholarPubMed
Passos, I. C., Mwangi, B., Cao, B., Hamilton, J. E., Wu, M.-J., Zhang, X. Y., … Soares, J. C. (2016). Identifying a clinical signature of suicidality among patients with mood disorders: A pilot study using a machine learning approach. Journal of Affective Disorders, 193, 109–116. doi: 10.1016/j.jad.2015.12.066.CrossRefGoogle ScholarPubMed
Perera, S., Eisen, R. B., Dennis, B. B., Bawor, M., Bhatt, M., Bhatnagar, N., … Samaan, Z. (2016). Body mass index is an important predictor for suicide: Results from a systematic review and meta-analysis. Suicide and Life-Threatening Behavior, 46(6), 697–736. doi: 10.1111/sltb.12244.CrossRefGoogle ScholarPubMed
Sareen, J., Cox, B. J., Stein, M. B., Afifi, T. O., Fleet, C., & Asmundson, G. J. G. (2007). Physical and mental comorbidity, disability, and suicidal behavior associated with posttraumatic stress disorder in a large community sample. Psychosomatic Medicine, 69(3), 242–248. doi: 10.1097/PSY.0b013e31803146d8.CrossRefGoogle Scholar
Schaffer, A., Isometsä, E. T., Tondo, L., Moreno, H, Turecki, D., Reis, G. … C., , … Yatham, L. N. (2014). International society for bipolar disorders task force on suicide: Meta-analyses and meta-regression of correlates of suicide attempts and suicide deaths in bipolar disorder. Bipolar Disorders, 17(1), 1–16. doi: 10.1111/bdi.12271.CrossRefGoogle ScholarPubMed
Slap, G., Goodman, E., & Huang, B. (2001). Adoption as a risk factor for attempted suicide during adolescence. Pediatrics, 108(2), e30. doi: 10.1542/peds.108.2.e30.CrossRefGoogle ScholarPubMed
Soloff, P. H., & Chiappetta, L. (2017). Suicidal behavior and psychosocial outcome in borderline personality disorder at 8-year follow-up. Journal of Personality Disorders, 31(6), 774–789. doi: 10.1521/pedi_2017_31_280.CrossRefGoogle ScholarPubMed
Temes, C. M., Frankenburg, F. R., Fitzmaurice, G. M., & Zanarini, M. C. (2019). Deaths by suicide and other causes among patients with borderline personality disorder and personality-disordered comparison subjects over 24 years of prospective follow-up. Journal of Clinical Psychiatry, 80(1), 30–36. doi: 10.4088/JCP.18m12436.Google ScholarPubMed
Tondo, L., Lepri, B., & Baldessarini, R. J. (2007). Suicidal risks among 2826 Sardinian major affective disorder patients. Acta Psychiatrica Scandinavica, 116(6), 419–428. doi: 10.1111/j.1600-0447.2007.01066.x.CrossRefGoogle ScholarPubMed
Torous, J., & Walker, R. (2019). Leveraging digital health and machine learning toward reducing suicide – from Panacea to practical tool. JAMA Psychiatry, 76(10), 999–1000. doi: 10.1001/jamapsychiatry.2019.1231.CrossRefGoogle ScholarPubMed
Turecki, G. (2014). The molecular bases of the suicidal brain. Nature Reviews Neuroscience, 15(12), 802–816. doi: 10.1038/nrn3839.CrossRefGoogle ScholarPubMed
Turecki, G., & Brent, D. A. (2015). Suicide and suicidal behaviour. The Lancet, 6736, 15. doi: 10.1016/S0140-6736(15)00234-2.Google Scholar
Tyrer, P., Reed, G. M., & Crawford, M. J. (2015). Classification, assessment, prevalence, and effect of personality disorder. The Lancet, 385(9969), 717–726. doi: 10.1016/S0140-6736(14)61995-4.CrossRefGoogle ScholarPubMed
Van Heeringen, K., & Mann, J. J. (2014). The neurobiology of suicide. The Lancet Psychiatry, 1(1), 63–72. doi: 10.1016/S2215-0366(14)70220-2.CrossRefGoogle ScholarPubMed
Walsh, C. G., Ribeiro, J. D., & Franklin, J. C. (2017). Predicting risk of suicide attempts over time through machine learning. Clinical Psychological Science, 5(3), 457–469. doi: 10.1177/2167702617691560.CrossRefGoogle Scholar
WHO. (2014). Preventing suicide: A global imperative. Geneva: World Health Organization. Retrieved from https://apps.who.int/iris/bitstream/handle/10665/131056/9789241564779_eng.pdf?sequence=1.Google Scholar
WHO. (2018). National suicide prevention strategies: Progress, examples and indicators. Geneva: World Health Organization. Retrieved from https://apps.who.int/iris/bitstream/handle/10665/279765/9789241515016-eng.pdf?ua=1.Google Scholar
Wilcox, H. C., Storr, C. L., & Breslau, N. (2009). Posttraumatic stress disorder and suicide attempts in a community sample of urban American young adults. Archives of General Psychiatry, 66(3), 305–311. doi: 10.1001/archgenpsychiatry.2008.557.CrossRefGoogle Scholar
Zalsman, G., Hawton, K., Wasserman, D., van Heeringen, K., Arensman, E., Sarchiapone, M., … Zohar, J. (2016). Suicide prevention strategies revisited: 10-year systematic review. The Lancet Psychiatry, 3(7), 646–659. doi: 10.1016/S2215-0366(16)30030-X.CrossRefGoogle ScholarPubMed
Zanarini, M. C., Frankenburg, F. R., Reich, D. B., Fitzmaurice, G., Weinberg, I., & Gunderson, J. G. (2008). The 10-year course of physically self-destructive acts reported by borderline patients and axis II comparison subjects. Acta Psychiatrica Scandinavica, 117(3), 177–184. doi: 10.1111/j.1600-0447.2008.01155.x.CrossRefGoogle ScholarPubMed
Zhang, J., Yan, F., Li, Y., & McKeown, R. E. (2013). Body mass index and suicidal behaviors: A critical review of epidemiological evidence. Journal of Affective Disorders, 148(2–3), 147–160. doi: 10.1016/j.jad.2012.05.048.CrossRefGoogle ScholarPubMed
Zou, H., & Hastie, T. (2005). Regularization and variable selection via the elastic net. Journal of the Royal Statistical Society Series B-Statistical Methodology, 67(2), 301–320. doi: 10.1111/j.1467-9868.2005.00503.x.CrossRefGoogle Scholar
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