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To the Editor.—
The recent evidence that we are failing to prevent suicide in the United States (225:992, 1973) necessitates some serious thinking about the reasons for this failure. As has been pointed out (Comp Psychiatry 13:555, 1972), part of the difficulty is in predicting who will kill himself. Because the incidence of suicide is so low and because predictive scales are far from perfect, the number of false positives (ie, individuals who the predictive scales predict to be potential suicides, but who do not kill themselves) is unmanageably high. For example, in a hospital of 12,000 psychiatric patients, with a scale that predicted with 75% accuracy, 3,020 patients would be predicted as potential suicides, of whom only 30 would actually kill themselves.This suggests that we could prevent suicide more easily if it were more common, in which case the proportion of false positives would be much lower.This
Lester D. The Prevention of Suicide. JAMA. 1974;228(1):26–27. doi:10.1001/jama.1974.03230260020010
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