Data_Sheet_1_Evaluating the Risk of Suicide and Violence in Severe Mental Illness: A Feasibility Study of Two Risk Assessment Tools (OxMIS and OxMIV) in General Psychiatric Settings.docx

BackgroundTwo OxRisk risk assessment tools, the Oxford Mental Illness and Suicide (OxMIS) and the Oxford Mental Illness and Violence (OxMIV), were developed and validated using national linked registries in Sweden, to assess suicide and violence risk in individuals with severe mental illness (schizophrenia-spectrum disorders and bipolar disorders). In this study, we aim to examine the feasibility and acceptability of the tools in three different clinical services.
MethodWe employed a two-step mixed-methods approach, by combining quantitative analyses of risk scores of 147 individual patients, and thematic analyses of qualitative data. First, 38 clinicians were asked to use OxMIS and OxMIV when conducting their routine risk assessments in patients with severe mental illness. The risk scores for each patient (which provide a probability of the outcome over 12 months) were then compared to the unstructured clinical risk assessment made by the treating clinician. Second, we carried out semi-structured interviews with the clinicians on the acceptability and utility of the tools. Thematic analysis was conducted on the qualitative data to identify common themes, in terms of the utility, accuracy, and acceptability of the tools. The investigations were undertaken in three general adult psychiatric clinics located in the cities of Barcelona and Sevilla (Spain), and Changsha (China).
ResultsMedian risk probabilities over 12 months for OxMIS were 1.0% in the Spanish patient sample and 1.9% in the Chinese sample. For OxMIV, they were 0.7% (Spanish) and 0.8% (Chinese). In the thematic analysis, clinicians described the tools as easy to use, and thought that the risk score improved risk management. Potential additions to predictors were suggested, including family history and the patient's support network. Concordance rates of risk estimates between the tools and clinicians was high for violence (94.4%; 68/72) and moderate for suicide (50.0%; 36/72).
ConclusionBoth OxMIS and OxMIV are feasible and practical in different general adult psychiatric settings. Clinicians interviewed found that both tools provide a useful structured approach to estimate the risk of suicide and violence. Risk scores from OxMIS and OxMIV can also be used to assist clinical decision-making for future management.

背景 两款OxRisk风险评估工具——牛津精神疾病与自杀风险评估工具（Oxford Mental Illness and Suicide, OxMIS）与牛津精神疾病与暴力风险评估工具（Oxford Mental Illness and Violence, OxMIV）——依托瑞典国家级关联登记数据库开发并完成验证，用于评估严重精神疾病（包括精神分裂谱系障碍与双相情感障碍）患者的自杀与暴力风险。本研究旨在考察这两款工具在三类不同临床服务场景中的可行性与可接受性。
方法 本研究采用两步式混合研究方法，整合147例患者风险评分的定量分析与定性数据的主题分析。首先，邀请38名临床医师在对严重精神疾病患者开展常规风险评估时使用OxMIS与OxMIV工具；随后将每位患者的风险评分（可给出12个月内不良结局的发生概率）与接诊医师的非结构化临床风险评估结果进行比对。其次，针对参与研究的临床医师开展半结构化访谈，以了解其对两款工具的可接受性与临床实用性；对访谈获取的定性数据开展主题分析，以识别与工具实用性、准确性及可接受性相关的共性研究主题。本研究的实施地点为西班牙巴塞罗那、塞维利亚以及中国长沙的三家普通成人精神科诊所。
结果 OxMIS的12个月中位风险概率在西班牙患者样本中为1.0%，中国患者样本中为1.9%；OxMIV的12个月中位风险概率则分别为西班牙样本0.7%、中国样本0.8%。主题分析结果显示，临床医师普遍认为两款工具易于操作，且风险评分有助于优化患者的风险管理流程；部分医师还提出可补充家族史与患者支持网络作为潜在预测因子。工具与临床医师的风险评估结果一致性表现为：暴力风险评估一致性达94.4%（68/72），自杀风险评估一致性处于中等水平（50.0%；36/72）。
结论 OxMIS与OxMIV两款工具在不同的普通成人精神科临床场景中均具备可行性与实用性。受访临床医师均认为，两款工具可为自杀与暴力风险评估提供结构化的实用评估路径；OxMIS与OxMIV生成的风险评分亦可辅助临床决策，为患者后续的临床管理提供支持。