title: Neural network identification of high-risk suicide patients.
abstract: BACKGROUND
  A history of medically serious suicide attempts (MSSA) has been considered a major risk factor for suicide. Backpropagation (BP) neural networks (NN) successfully detected patient files of patients who had committed MSSA but failed to identify MSSA patients when trained with data collected during face-to-face interviews.
  
  
  OBJECTIVE
  To develop an expert support system for the detection of suicide risk in patients with major psychiatric disorders using fuzzy adaptive learning control networks (FALCON) and BP enhanced with fuzzy logic neural networks.
  
  
  METHODS
  We used four types of input sets: (a) the most significant variables as defined by Garson's calculation of trained BP; (b) variables identified by logistic regression; (c) variables considered significant by experienced clinicians; or (d) the variables considered definitive by the computer programmer. In addition, the complete set of 59 input variables was used. The target variable was the existence of prior MSSA.
  
  
  METHODS
  Four training trials were performed with each input set (75% of the data was used for training and 25% for testing). Data was collected from 197 (50 MSSA, 147 non-MSSA) patients hospitalized at Sha'ar Menashe Mental Health Centre.
  
  
  RESULTS
  BP enhanced with fuzzy logic achieved the most accurate results with the three variables chosen by the programmer (mean +/- SD; sensitivity=97% +/- 3.4%, specificity=69.2% +/- 6.9%), and FALCON trained with 15 variables chosen by an expert clinician obtained the highest sensitivity and specificity (mean +/- SD; sensitivity=94% +/- 6.9%, specificity=69% +/- 6.9%).
  
  
  CONCLUSIONS
  A combined system of BP enhanced with fuzzy logic and FALCON may improve the detection rate of MSSA patients during patient interviews. A prospective validation study testing a combined system across 1, 2 and 5-year spans may provide a reliable instrument to aid in the detection of suicide prone psychiatric patients.
authors.affiliation: Sh'ar Menashe Mental Health Center, Institute of Psychiatric Studies, Hadera, Israel. shrmodai@matat.health.gov.il
authors.forename: Ilan
authors.initials: I
authors.lastname: Modai
authors.forename: Rena
authors.initials: R
authors.lastname: Kurs
authors.forename: Michael
authors.initials: M
authors.lastname: Ritsner
authors.forename: Svetlana
authors.initials: S
authors.lastname: Oklander
authors.forename: Henry
authors.initials: H
authors.lastname: Silver
authors.forename: Alexander
authors.initials: A
authors.lastname: Segal
authors.forename: Imri
authors.initials: I
authors.lastname: Goldberg
authors.forename: Shalom
authors.initials: S
authors.lastname: Mendel
mesh_terms: D000328:Adult; D005103:Expert Systems; D005260:Female; D017143:Fuzzy Logic; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008297:Male; D001523:Mental Disorders / Q000150:complications / Q000175:diagnosis*; D008875:Middle Aged; D016571:Neural Networks, Computer; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013406:Suicide, Attempted / Q000706:statistics & numerical data*