USER GUIDE

Version 0.1 – June 2019

 

OxMIS is a web-based risk calculator for assessing risk of suicide in individuals with severe mental illness. This tool was developed by the Forensic Psychiatry and Psychology group at the University of Oxford and is available on the OxRisk.com website.

How was it developed?

OxMIS was derived and externally validated in Sweden, using data from a  national  cohort of  75158  individuals aged  15-65  years with  a  diagnosis of  severe  mental illness  (schizophrenia  spectrum or  bipolar  disorder) between  2001 and 2008. Potential predictive variables for inclusion in OxMIS were drawn from carefully reviewing the evidence on criminal and self-harm history, sociodemographic, family, and clinical factors, and considering only those that were both reliable risk factors, and relatively easy to score.

First, the OxMIS model was derived using the data from 58 771 patients, and 17 mostly routinely collected history of violence, sociodemographic, family, and clinical factors were included in the final model. Then, the model was externally validated in a distinct group of 16 387 patients to establish its performance in a new sample. The model generates a simple risk calculator (OxMIS) that generates one output – probability scores (%) based on 12 months suicide.

The research behind OxMIS has been peer-reviewed and published in the Translational Psychiatry journal (Open Access). Further validations in different countries are planned. For a full bibliography related to OxMIS, visit the OxRisk.com website. 

When should OxMIS be used for?

OxMIV is designed to predict suicide within 12 months in individuals with a  diagnosis  of severe  mental  illness (schizophrenia  spectrum  or bipolar  disorder).

Who should use OxMIS?

Healthcare staff can use the OxMIS tool, as scoring to specific cases requires interpretation of some of the predictor variables. Individuals who use OxMIS are encouraged to read other background literature (including the published papers about OxMIS, all freely available on OxRisk.com) and any training videos developed locally within individual countries.

How should the outputs be interpreted?

The outputs from the OxMIS calculator include probability scores for suicide within 12 months. This can be used as an adjunct to full clinical assessment. A probability of 5% for 12 months means that, on average, 5 in 100 individuals with the same predictors will die by suicide over the next 12 months. This is a similar interpretation to the chance of rain in a weather app – so a 10% chance of rain at a certain time will mean that on similar days as today, there is a 1 in 10 chance of rain. The tool can be used to help screen out individuals at the lower end of the risk spectrum as the tool performs most strongly in identifying individuals with risk levels in the range of 0-1%. Therefore, using this in combination with clinical judgement can assist in decisions such as resource allocation and safety planning.

How should each item be scored?

See item descriptions on the scoring sheet. The best and most recent source of information should be used if possible. Some variables can be scored as unknown, and OxMIS will display risk ranges to reflect this uncertainty.