The Modular Assessment of Risk for Imminent Suicide (MARIS): A proof of concept for a multi-informant tool for evaluation of short-term suicide risk

Compr Psychiatry. 2017 Jan;72:88-96. doi: 10.1016/j.comppsych.2016.10.002. Epub 2016 Oct 7.


Background: To date, no diagnostic tool has demonstrated clinical value for the assessment of short-term suicide risk among high-risk individuals. To this end we have developed the Modular Assessment of Risk for Imminent Suicide (MARIS), a modular patient and clinician informed risk evaluation instrument. Here we assess its predictive validity for suicidal behavior (SB) in psychiatric patients following discharge from an inpatient unit.

Methods: The MARIS and a psychological test battery were administered to 136 adult psychiatric patients hospitalized for high risk of suicide. Eighty-six participants had complete data at discharge and 59 (69.8%) were reached for follow-up. Logistic regressions were used to assess the predictive validity of the MARIS for SB over the 4-8weeks following hospital discharge and its incremental predictive validity over standard risk factors.

Results: Patients who exhibited SB in the period between initial assessment and follow-up had significantly higher MARIS scores. ROC analysis indicated good sensitivity and specificity of MARIS in identifying risk (OR=19). Further, MARIS total score significantly improved predictive validity by the standard risk factors when added to a model comprising global depression severity, hopelessness, and lifetime number of suicide attempts, and was the only factor that approached independent significance.

Conclusion: The MARIS appears to be a practical and effective tool for detecting short-term suicide risk following hospital discharge, supporting the validity of modular multi-informant approach to suicide risk evaluation. Replication of these findings and further investigation of the applications of such an approach are warranted.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Patient Discharge / standards
  • Psychological Tests / standards*
  • Risk Assessment
  • Risk Factors
  • Self-Injurious Behavior / diagnosis
  • Self-Injurious Behavior / epidemiology
  • Self-Injurious Behavior / psychology
  • Sensitivity and Specificity
  • Suicidal Ideation*
  • Suicide / psychology*
  • Suicide, Attempted / psychology*
  • Time Factors
  • Young Adult