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Improper study design precludes valid effect estimates in important suicide prevention research
Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Psychiatry. Emotra AB Ltd, Sweden.
Karl Wahlin AB, Sweden.
Mdas AB, Sweden.
2019 (English)In: International Journal of Methods in Psychiatric Research, ISSN 1049-8931, E-ISSN 1557-0657, Vol. 28, no 3, article id e1786Article in journal, Letter (Other academic) Published
Abstract [en]

The observational study design for estimating accuracy of diagnostic tests for suicide risk in clinical work is not ideal, due to the effects of directed suicide prevention to the high-risk group. This is an example of the confounding by indication and protopathic bias, which lead to misinterpretation of the accuracy terms sensitivity and specificity. The simple arithmetic mechanism presented here, forces the conclusion that the accuracy estimates sensitivity and specificity, applied in open prospective trials of surmised diagnostic tests for suicide risk, cannot be normally interpreted as accuracy estimators. Further, the related concept "prediction of suicide" is shown to be fundamentally illogical and should not be used in the present context. All these statements reveal a far-reaching problem within the suicide prevention research: Conclusions regarding the usefulness of diagnostic tests of suicide risk in the vast previous research since decades deserve reinterpretation. Diagnostic tests per se, can possess highly qualitative properties in estimating important suicidological aspects regarding a patient, but, when studied in an open design study, it cannot be demonstrated. This problem concerns rating scales and any biological and psychological tests in medicine, when confounding factors, for example, suicide prevention, influence the outcome because of the test result per se.

Place, publisher, year, edition, pages
John Wiley & Sons, 2019. Vol. 28, no 3, article id e1786
Keywords [en]
confounding by indication; naturalistic studies; sensitivity; suicide prevention research; trials of diagnostic tests for suicide risk
National Category
Psychiatry
Identifiers
URN: urn:nbn:se:liu:diva-161864DOI: 10.1002/mpr.1786ISI: 000492720900013PubMedID: 31144394Scopus ID: 2-s2.0-85066466243OAI: oai:DiVA.org:liu-161864DiVA, id: diva2:1374094
Available from: 2019-11-28 Created: 2019-11-28 Last updated: 2019-12-05Bibliographically approved

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Thorell, Lars-Håkan

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