Evidence map›Paper›PMID 26370729›Full record

SynthesisPsychological medicine2016

Self-injurious thoughts and behaviors as risk factors for future suicide ideation, attempts, and death: a meta-analysis of longitudinal studies.

J D Ribeiro, J C Franklin, K R Fox, K H Bentley, E M Kleiman, B P Chang, M K Nock

Open access · bronzeAbstract readMeta-AnalysisReview
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Psychological medicine, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 569 papers, 10 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
569citing papers in PubMed, 10 pooled it
60.6field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

569 citing papers in PubMed, 10 syntheses or guidelines pooled it, 1,268 citations in OpenAlex.

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  17. Efficacy of a brief psychological intervention for adolescents with recent suicide attempt: A randomized clinical trial.European psychiatry : the journal of the Association of European Psychiatrists · 2025
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509 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

7 authors at 4 institutions in 1 country.

J D RibeiroDepartment of Psychology,Harvard University,Cambridge,MA,USA.
J C FranklinDepartment of Psychology,Harvard University,Cambridge,MA,USA.
K R FoxDepartment of Psychology,Harvard University,Cambridge,MA,USA.
K H BentleyCenter for Anxiety and Related Disorders,Boston University,Boston,MA,USA.
E M KleimanDepartment of Psychology,Harvard University,Cambridge,MA,USA.
B P ChangDepartment of Medicine,Columbia University,New York,NY,USA.
M K NockDepartment of Psychology,Harvard University,Cambridge,MA,USA.
Harvard University · USBoston University · USColumbia University · USVanderbilt University · US

Funding

LIFE-SPAN DEVELOPMENT OF NORMAL AND ABNORMAL BEHAVIORT32MH018921 · NIMH · VANDERBILT UNIVERSITY · PI HUMPHREYS, KATHRYN LEIGH · 1989 to 2024
$6.7M
NIMH NIH HHS T32 MH018921NIMH NIH HHS T32MH18921
6 · The paper itself

Abstract

backgroundA history of self-injurious thoughts and behaviors (SITBs) is consistently cited as one of the strongest predictors of future suicidal behavior. However, stark discrepancies in the literature raise questions about the true magnitude of these associations. The objective of this study is to examine the magnitude and clinical utility of the associations between SITBs and subsequent suicide ideation, attempts, and death.

methodWe searched PubMed, PsycInfo, and Google Scholar for papers published through December 2014. Inclusion required that studies include at least one longitudinal analysis predicting suicide ideation, attempts, or death using any SITB variable. We identified 2179 longitudinal studies; 172 met inclusion criteria.

resultsThe most common outcome was suicide attempt (47.80%), followed by death (40.50%) and ideation (11.60%). Median follow-up was 52 months (mean = 82.52, s.d. = 102.29). Overall prediction was weak, with weighted mean odds ratios (ORs) of 2.07 [95% confidence interval (CI) 1.76-2.43] for ideation, 2.14 (95% CI 2.00-2.30) for attempts, and 1.54 (95% CI 1.39-1.71) for death. Adjusting for publication bias further reduced estimates. Diagnostic accuracy analyses indicated acceptable specificity (86-87%) and poor sensitivity (10-26%), with areas under the curve marginally above chance (0.60-0.62). Most risk factors generated OR estimates of <2.0 and no risk factor exceeded 4.5. Effects were consistent regardless of sample severity, sample age groups, or follow-up length.

conclusionsPrior SITBs confer risk for later suicidal thoughts and behaviors. However, they only provide a marginal improvement in diagnostic accuracy above chance. Addressing gaps in study design, assessment, and underlying mechanisms may prove useful in improving prediction and prevention of suicidal thoughts and behaviors.

Indexed as

Suicidal IdeationHumansLongitudinal StudiesMortalityRisk FactorsSelf-Injurious BehaviorSuicideSuicide, AttemptedLongitudinalmeta-analysispredictionsuicidal ideationsuicidesuicide attempt

Identifiers

PMID26370729
PMCPMC4774896
OpenAlexW1893670457

What OpenQuestion holds

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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.