Title: A systematic review of validated suicide outcome classification in observational studies

Journal Article · · International Journal of Epidemiology
DOI: https://doi.org/10.1093/ije/dyz038 · OSTI ID:1575969
 [1];  [1];  [1];  [1];  [1];  [1]
  1. Food and Drug Administration, Center for Drug Evaluation and Research, Office of Surveillance and Epidemiology, Divisions of Epidemiology I and II, Silver Spring, MD, USA
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Abstract Background Suicidal outcomes, including ideation, attempt, and completed suicide, are an important drug safety issue, though few epidemiological studies address the accuracy of suicidal outcome ascertainment. Our primary objective was to evaluate validated methods for suicidal outcome classification in electronic health care database studies. Methods We performed a systematic review of PubMed and EMBASE to identify studies that validated methods for suicidal outcome classification published 1 January 1990 to 15 March 2016. Abstracts and full texts were screened by two reviewers using prespecified criteria. Sensitivity, specificity, and predictive value for suicidal outcomes were extracted by two reviewers. Methods followed PRISMA-P guidelines, PROSPERO Protocol: 2016: CRD42016042794. Results We identified 2202 citations, of which 34 validated the accuracy of measuring suicidal outcomes using International Classification of Diseases (ICD) codes or algorithms, chart review or vital records. ICD E-codes (E950-9) for suicide attempt had 2–19% sensitivity, and 83–100% positive predictive value (PPV). ICD algorithms that included events with ‘uncertain’ intent had 4–70% PPV. The three best-performing algorithms had 74–92% PPV, with improved sensitivity compared with E-codes. Read code algorithms had 14–68% sensitivity and 0–56% PPV. Studies estimated 19–80% sensitivity for chart review, and 41–97% sensitivity and 100% PPV for vital records. Conclusions Pharmacoepidemiological studies measuring suicidal outcomes often use methodologies with poor sensitivity or predictive value or both, which may result in underestimation of associations between drugs and suicidal behaviour. Studies should validate outcomes or use a previously validated algorithm with high PPV and acceptable sensitivity in an appropriate population and data source.

Sponsoring Organization:
USDOE
OSTI ID:
1575969
Journal Information:
International Journal of Epidemiology, Journal Name: International Journal of Epidemiology Journal Issue: 5 Vol. 48; ISSN 0300-5771
Publisher:
Oxford University PressCopyright Statement
Country of Publication:
United Kingdom
Language:
English

References (57)

Prevalence, Correlates, and Treatment of Lifetime Suicidal Behavior Among Adolescents: Results From the National Comorbidity Survey Replication Adolescent Supplement journal March 2013
Suicidality in Pediatric Patients Treated With Antidepressant Drugs journal March 2006
Risk of Suicide Among US Military Service Members Following Operation Enduring Freedom or Operation Iraqi Freedom Deployment and Separation From the US Military journal June 2015
Association between body mass index and suicide, and suicide attempt among british adults: The health improvement network database: Suicide in Relation to Body Mass Index journal March 2013
Validation of death and suicide recording on the THIN UK primary care database journal February 2009
Identification of hospitalizations for intentional self-harm when E-codes are incompletely recorded journal October 2010
A systematic review of validated methods for identifying suicide or suicidal ideation using administrative or claims data: METHODS FOR IDENTIFYING SUICIDE USING CLAIMS DATA journal January 2012
Identifying suicidal behavior among adolescents using administrative claims data: IDENTIFYING SUICIDAL BEHAVIOR USING CLAIMS DATA journal February 2013
How complete are E-codes in commercial plan claims databases? journal January 2014
Verification of information in a large medical database using linkages with external databases journal March 1995
Reliability of causes of death in persons with Type I diabetes journal November 2002
Hospitalization for suicide attempt and completed suicide: epidemiological features in a managed care population journal August 2000
All-Cause and Cause-Specific Mortality Associated with Bariatric Surgery: A Review journal October 2015
An analysis of unnatural deaths between 1990 and 1994 in A-Lein, Taiwan journal April 1997
The reporting of in-patient suicides: identifying the problem journal July 1995
The Validity of the Certification of Manner of Death by Ontario Coroners journal November 2006
The PHQ-9 Item 9 based screening for suicide risk: a validation study of the Patient Health Questionnaire (PHQ)−9 Item 9 with the Columbia Suicide Severity Rating Scale (C-SSRS) journal May 2018
A study of suicides in Kildare, 1995–2002 journal December 2004
Causes of premature mortality in Swedish drug abusers: A prospective longitudinal study 1970–2006 journal February 2011
Comparison of Electronic Screening for Suicidal Risk With the Patient Health Questionnaire Item 9 and the Columbia Suicide Severity Rating Scale in an Outpatient Psychiatric Clinic journal September 2015
Suicide attempts, plans, and ideation in culturally diverse sites: the WHO SUPRE-MISS community survey journal July 2005
Suicidal Adverse Events in Pediatric Randomized, Controlled Clinical Trials of Antidepressant Drugs Are Associated with Active Drug Treatment: AMeta-Analysis journal March 2006
Bias from Nondifferential but Dependent Misclassification of Exposure and Outcome journal January 1992
Antidepressant Drugs and Suicide journal January 1992
Severe Depression, Suicide Attempts, and Ideation During the Use of Interferon Beta by Patients With Multiple Sclerosis journal January 2010
Understanding the Direction of Bias in Studies of Diagnostic Test Accuracy journal November 2013
Validation of suicide and self-harm records in the Clinical Practice Research Datalink: Validation of suicide and self-harm records journal June 2013
Risk of suicide attempt and suicide death in patients treated for bipolar disorder journal August 2007
Suicide decline in Australia: where did the cases go? journal February 2009
A Consideration of the Validity and Reliability of Suicide Mortality Data journal March 1989
Using Structured Telephone Follow-up Assessments to Improve Suicide-Related Adverse Event Detection journal March 2014
SAT0336 Development of an Algorithm to Identify Serious Opioid Toxicity in Children journal June 2015
Association between suicide attempts and selective serotonin reuptake inhibitors: systematic review of randomised controlled trials journal February 2005
Risk of suicidality in clinical trials of antidepressants in adults: analysis of proprietary data submitted to US Food and Drug Administration journal August 2009
Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation journal January 2015
Classifying undetermined poisoning deaths journal October 2006
Non-differential misclassification of exposure always leads to an underestimate of risk: an incorrect conclusion. journal December 1994
Non-differential misclassification and bias towards the null: a clarification. journal August 1995
Suicide Attempts Among Patients Starting Depression Treatment With Medications or Psychotherapy journal July 2007
Columbia Classification Algorithm of Suicide Assessment (C-CASA): Classification of Suicidal Events in the FDA’s Pediatric Suicidal Risk Analysis of Antidepressants journal July 2007
Association of Hormonal Contraception With Suicide Attempts and Suicides journal April 2018
Does Response on the PHQ-9 Depression Questionnaire Predict Subsequent Suicide Attempt or Suicide Death? journal December 2013
Changes in Coding of Suicide Attempts or Self-Harm With Transition From ICD-9 to ICD-10 journal March 2017
The Coroner's System and Under-Reporting of Suicide journal October 1995
Antecedents of hospital admission for deliberate self-harm from a 14-year follow-up study using data-linkage journal October 2010
Validation of key behaviourally based mental health diagnoses in administrative data: suicide attempt, alcohol abuse, illicit drug abuse and tobacco use journal January 2012
Validation of ICD-9-CM codes for identification of acetaminophen-related emergency department visits in a large pediatric hospital journal February 2013
Driver suicides journal November 1997
Psychological autopsy study of suicides by people aged under 35 journal August 1999
Open verdict v. suicide – importance to research journal May 2001
Occult suicidality in an emergency department population journal April 2005
Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement journal July 2009
Selective serotonin reuptake inhibitors and risk of suicide: a systematic review of observational studies journal February 2009
Antidepressants and Suicide Attempts in Children journal January 2014
Qualidade da informação sobre causas externas no Sistema de Informações Hospitalares journal January 2009
Strategies for Quantifying the Relationship between Medications and Suicidal Behaviour: What has been Learned? journal January 2011
Monitoring Suicidal Patients in Primary Care Using Electronic Health Records journal January 2015

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