These searches yielded an excessive number of titles when the term ‘suicide’ was used as a keyword (>200 000) or in the title (>70 000). Multiple search strategies were initially explored using the databases Medline, Embase and PsycINFO from inception to January 2017. We report a meta-analysis of cohort and case–control studies that examined the presence or absence of expressed suicidal ideation among those who later did or did not die by suicide. 11 Moreover, existing meta-analyses of the association between suicide and suicidal ideation have been limited to studies with a cohort design, 9 only included patients with particular diagnoses 7 or included studies where suicidal ideation was established post-mortem using psychological autopsy methods. Knowledge of the sensitivity of suicidal ideation for later suicide is particularly important because screening tests should be sufficiently sensitive, such that a high proportion of affected people screen positive. 8 To date, no meta-analysis has examined the sensitivity and specificity of suicidal ideation for suicide. Several meta-analyses have highlighted the modest strength of the association between suicidal ideation and later suicide 7 – 10 and one has quantified the positive predictive value (PPV). 5, 6ĭespite the undoubted clinical importance of suicidal ideation, meta-analysis has only been used recently to estimate the statistical strength of suicidal ideation as a test for later suicide. 3 In addition, suicidal ideation is sometimes considered to be the most important sign of short-term suicide risk, 4 and it has been argued that questions about suicidal ideation play a crucial role in suicide screening. 1 The presence of thoughts of suicide and the expression of suicidal ideation are signs of significant distress, and all patients who express suicidal ideation require a careful clinical assessment 2, 3 leading to a comprehensive treatment plan. Health professionals are expected to have the skills to assess and manage patients with suicidal thoughts. Project Synergy is a 3-year programme for the transformation of mental health services through the use of innovative technologies. InnoWell has been formed by the University of Sydney and PricewaterhouseCoopers to administer the $30 M Australian Government Funded Project Synergy. He is the Chief Scientific Advisor to, and an equity shareholder in, InnoWell. He was a member of the Medical Advisory Panel for Medibank Private until October 2017. He is a Board Member of Psychosis Australia Trust and a member of Veterans Mental Health Clinical Reference group. has previously led community-based and pharmaceutical industry-supported (Wyeth, Eli Lily, Servier, Pfizer, AstraZeneca) projects focused on the identification and better management of anxiety and depression. The BMC operates an early-intervention youth services at Camperdown under contract to Headspace. He is the Co-Director, Health and Policy at the Brain and Mind Centre (BMC) University of Sydney. has been a Commissioner in Australia's National Mental Health Commission since 2012. have provided expert evidence in civil, criminal and coronial matters. 96%) than studies conducted in non-psychiatric settings. 22%) and lower pooled specificity (81% v. Studies of suicidal ideation expressed by current and former psychiatric patients had a significantly higher pooled sensitivity (46% v. The pooled sensitivity of suicidal ideation for later suicide was 41% (95% CI 35–48) and the pooled specificity was 86% (95% CI 76–92), with high between-study heterogeneity. Studies conducted in primary care and other non-psychiatric settings had similar pooled odds to studies of current and former psychiatric patients (OR = 3.86 v.
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