Psychiatric aftercare and suicide risk: a case-control study using blind rating.

Blindly abstracted records of last episode of care together with aftercare records of 39 psychiatric patient suicides and their matched controls were rated blind for suicidal talk during aftercare, reduction of aftercare at last appointment and high-low suicide risk. Neither suicidal talk nor reduction of aftercare was confirmed as a predictor of suicide, although trends in the predicted directions were observed. Blind estimates of high-low risk correctly identified a significant minority (40%) of suicides but at the cost of misclassifying 60% as controls. Evidence is still lacking that clinicians blind to case identity may, from records, reliably distinguish a majority of suicides from their matched controls. Some implications for practice and research are discussed.

Can suicides be identified from case records? A case control study using blind rating.

A majority of case control studies of suicide risks in psychiatric patients reveal an excess of risk factors in cases. None of the case control studies has been conducted blind to case identity. The present study examined the possibility that skilled clinicians could identify suicides blind from case records of last episode of care. Records of 39 suicides of psychiatric patients and their matched controls (N = 78) were abstracted blind and dichotomously rated for suicide by seven raters. Success in identification of cases approximated to chance expectation. Pending replication, these disappointing findings call in question the clinical utility of risk factor findings to date, their validity as a basis for significant change in service provision and the medico-legal significance of records in suicide-related civil law suits.