title: Re-examination of classic risk factors for suicidal behavior in the psychiatric population.
abstract: BACKGROUND
  For decades we have understood the risk factors for suicide in the general population but have fallen short in understanding what distinguishes the risk for suicide among patients with serious psychiatric conditions.
  
  
  OBJECTIVE
  This prompted us to investigate risk factors for suicidal behavior among psychiatric inpatients.
  
  
  METHODS
  We reviewed all psychiatric hospital admissions (2008-2011) to a centralized psychiatric hospital in Ontario, Canada. Using multivariable logistic regression we evaluated the association between potential risk factors and lifetime history of suicidal behavior, and constructed a model and clinical risk score to predict a history of this behavior.
  
  
  RESULTS
  The final risk prediction model for suicidal behavior among psychiatric patients (n = 2,597) included age (in three categories: 60-69 [OR = 0.74, 95% CI = 0.73-0.76], 70-79 [OR = 0.45, 95% CI = 0.44-0.46], 80+ [OR = 0.31, 95% CI = 0.30-.31]), substance use disorder (OR = 1.30, 95% CI = 1.27-1.32), mood disorder (OR = 1.49, 95% CI = 1.47-1.52), personality disorder (OR = 2.30, 95% CI = 2.25-2.36), psychiatric disorders due to general medical condition (OR = 0.52, 95% CI = 0.50-0.55), and schizophrenia (OR = 0.42, 95% CI = 0.41-0.43). The risk score constructed from the risk prediction model ranges from -9 (lowest risk, 0% predicted probability of suicidal behavior) to +5 (highest risk, 97% predicted probability).
  
  
  CONCLUSIONS
  Risk estimation may help guide intensive screening and treatment efforts of psychiatric patients with high risk of suicidal behavior.
authors.affiliation: 1 St. George's University of London, UK.|2 Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.
authors.forename: Brittany B
authors.initials: BB
authors.lastname: Dennis
authors.affiliation: 3 Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada.
authors.forename: Pavel S
authors.initials: PS
authors.lastname: Roshanov
authors.affiliation: 1 St. George's University of London, UK.|4 McMaster Integrative Neuroscience and Discovery Program, McMaster University, Hamilton, ON, Canada.
authors.forename: Monica
authors.initials: M
authors.lastname: Bawor
authors.affiliation: 5 Population Health Research Institute, Hamilton Health Sciences/McMaster University, Hamilton, ON, Canada.
authors.forename: Wala
authors.initials: W
authors.lastname: ElSheikh
authors.affiliation: 6 St. Joseph's Healthcare Hamilton, ON, Canada.
authors.forename: Sue
authors.initials: S
authors.lastname: Garton
authors.affiliation: 5 Population Health Research Institute, Hamilton Health Sciences/McMaster University, Hamilton, ON, Canada.
authors.forename: Jane
authors.initials: J
authors.lastname: DeJesus
authors.affiliation: 5 Population Health Research Institute, Hamilton Health Sciences/McMaster University, Hamilton, ON, Canada.
authors.forename: Sumathy
authors.initials: S
authors.lastname: Rangarajan
authors.affiliation: 6 St. Joseph's Healthcare Hamilton, ON, Canada.
authors.forename: Judith
authors.initials: J
authors.lastname: Vair
authors.affiliation: 6 St. Joseph's Healthcare Hamilton, ON, Canada.
authors.forename: Heather
authors.initials: H
authors.lastname: Sholer
authors.affiliation: 6 St. Joseph's Healthcare Hamilton, ON, Canada.
authors.forename: Nichole
authors.initials: N
authors.lastname: Hutchinson
authors.affiliation: 6 St. Joseph's Healthcare Hamilton, ON, Canada.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Lordan
authors.affiliation: 2 Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.
authors.forename: Lehana
authors.initials: L
authors.lastname: Thabane
authors.affiliation: 2 Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.|7 Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, ON, Canada.|8 Peter Boris Centre for Addictions Research, St. Joseph's Healthcare Hamilton, ON, Canada.
authors.forename: Zainab
authors.initials: Z
authors.lastname: Samaan
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D019964:Mood Disorders / Q000453:epidemiology*; D015999:Multivariate Analysis; D009864:Ontario / Q000453:epidemiology; D010554:Personality Disorders / Q000453:epidemiology*; D012307:Risk Factors; D012559:Schizophrenia / Q000453:epidemiology*; D019966:Substance-Related Disorders / Q000453:epidemiology*; D013405:Suicide / Q000706:statistics & numerical data*; D013406:Suicide, Attempted / Q000706:statistics & numerical data
keywords: psychiatric comorbidity; risk prediction; risk score; suicidal risk