BACKGROUND Worldwide, nearly 800,000 individuals die by suicide each year; however, longitudinal prediction of suicide attempts remains a major challenge within the field of psychiatry. The objective of the present research was to develop and evaluate an evidence-based suicide attempt risk checklist [i.e., the Durham Risk Score (DRS)] to aid clinicians in the identification of individuals at risk for attempting suicide in the future. METHODS AND FINDINGS Three prospective cohort studies, including a population-based study from the United States [i.e., the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) study] as well as 2 smaller US veteran cohorts [i.e., the Assessing and Reducing Post-Deployment Violence Risk (REHAB) and the Veterans After-Discharge Longitudinal Registry (VALOR) studies], were used to develop and validate the DRS. From a total sample size of 35,654 participants, 17,630 participants were selected to develop the checklist, whereas the remaining participants (N = 18,024) were used to validate it. The main outcome measure was future suicide attempts (i.e., actual suicide attempts that occurred after the baseline assessment during the 1- to 3-year follow-up period). Measure development began with a review of the extant literature to identify potential variables that had substantial empirical support as longitudinal predictors of suicide attempts and deaths. Next, receiver operating characteristic (ROC) curve analysis was utilized to identify variables from the literature review that uniquely contributed to the longitudinal prediction of suicide attempts in the development cohorts. We observed that the DRS was a robust prospective predictor of future suicide attempts in both the combined development (area under the curve [AUC] = 0.91) and validation (AUC = 0.92) cohorts. A concentration of risk analysis found that across all 35,654 participants, 82% of prospective suicide attempts occurred among individuals in the top 15% of DRS scores, whereas 27% occurred in the top 1%. The DRS also performed well among important subgroups, including women (AUC = 0.91), men (AUC = 0.93), Black (AUC = 0.92), White (AUC = 0.93), Hispanic (AUC = 0.89), veterans (AUC = 0.91), lower-income individuals (AUC = 0.90), younger adults (AUC = 0.88), and lesbian, gay, bisexual, transgender, and queer or questioning (LGBTQ) individuals (AUC = 0.88). The primary limitation of the present study was its its reliance on secondary data analyses to develop and validate the risk score. CONCLUSIONS In this study, we observed that the DRS was a strong predictor of future suicide attempts in both the combined development (AUC = 0.91) and validation (AUC = 0.92) cohorts. It also demonstrated good utility in many important subgroups, including women, men, Black, White, Hispanic, veterans, lower-income individuals, younger adults, and LGBTQ individuals. We further observed that 82% of prospective suicide attempts occurred among individuals in the top 15% of DRS scores, whereas 27% occurred in the top 1%. Taken together, these findings suggest that the DRS represents a significant advancement in suicide risk prediction over traditional clinical assessment approaches. While more work is needed to independently validate the DRS in prospective studies and to identify the optimal methods to assess the constructs used to calculate the score, our findings suggest that the DRS is a promising new tool that has the potential to significantly enhance clinicians' ability to identify individuals at risk for attempting suicide in the future.

中文翻译：

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用于估计自杀未遂风险的达勒姆风险评分的开发和验证：前瞻性队列分析。

背景 全世界每年有近 800,000 人死于自杀；然而，自杀企图的纵向预测仍然是精神病学领域的一个重大挑战。本研究的目的是开发和评估基于证据的自杀未遂风险检查表[即达勒姆风险评分（DRS）]，以帮助临床医生识别未来有自杀未遂风险的个人。方法和结果 三项前瞻性队列研究，包括一项来自美国的基于人群的研究[即全国酒精及相关疾病流行病学调查 (NESARC) 研究]以及 2 个较小的美国退伍军人队列研究[即评估和减少酒精摄入量研究]部署后暴力风险 (REHAB) 和退伍军人退役后纵向登记 (VALOR) 研究]用于开发和验证 DRS。从 35,654 名参与者的总样本量中，选择了 17,630 名参与者来制定清单，而其余参与者 (N = 18,024) 用于验证它。主要结果指标是未来的自杀企图（即基线评估后1至3年随访期间发生的实际自杀企图）。衡量标准的制定始于对现有文献的回顾，以确定具有大量实证支持的潜在变量，作为自杀未遂和死亡的纵向预测因素。接下来，利用受试者工作特征（ROC）曲线分析来识别文献综述中的变量，这些变量对发展队列中自杀企图的纵向预测有独特的贡献。我们观察到，在联合开发（曲线下面积 [AUC] = 0.91）和验证（AUC = 0.92）队列中，DRS 是未来自杀企图的强有力的前瞻性预测因子。一项集中风险分析发现，在所有 35,654 名参与者中，82% 的预期自杀企图发生在 DRS 评分前 15% 的个体中，而 27% 发生在前 1% 的个体中。DRS 在重要亚组中也表现良好，包括女性 (AUC = 0.91)、男性 (AUC = 0.93)、黑人 (AUC = 0.92)、白人 (AUC = 0.93)、西班牙裔 (AUC = 0.89)、退伍军人 (AUC = 0.91) ）、低收入个体（AUC = 0.90）、年轻人（AUC = 0.88）以及女同性恋、男同性恋、双性恋、跨性别者和酷儿或疑问者（LGBTQ）个体（AUC = 0.88）。本研究的主要局限性是它依赖二手数据分析来制定和验证风险评分。结论 在这项研究中，我们观察到，在联合开发组 (AUC = 0.91) 和验证组 (AUC = 0.92) 中，DRS 是未来自杀企图的强有力预测因子。它还在许多重要的亚群体中表现出良好的实用性，包括女性、男性、黑人、白人、西班牙裔、退伍军人、低收入个人、年轻人和 LGBTQ 个人。我们进一步观察到，82% 的预期自杀企图发生在 DRS 得分前 15% 的个体中，而 27% 发生在前 1% 的个体中。总而言之，这些研究结果表明，与传统的临床评估方法相比，DRS 在自杀风险预测方面取得了重大进步。虽然需要做更多的工作来在前瞻性研究中独立验证 DRS 并确定评估用于计算分数的结构的最佳方法，但我们的研究结果表明 DRS 是一种有前途的新工具，有可能显着提高临床医生的能力识别未来有自杀企图风险的个人。