REVIEW OF: Torino G et al, J Affect Disord 2025;381:321–328
STUDY TYPE: Meta-analysis

The Oxford Mental Illness and Suicide tool (OxMIS; https://oxrisk.com/oxmis) is a free and validated online calculator of suicide risk in patients with bipolar or schizophrenia spectrum disorders. Users input 17 clinical and social variables for a patient and receive an estimate of that patient’s risk of attempting suicide within the next 12 months. This study assessed the evidence for OxMIS.

From the two studies they included, researchers calculated a pooled odds ratio of 3.42 (95% CI: 3.09–3.77) for OxMIS, indicating that patients categorized as high risk were over 3 times more likely to die by suicide than their low-risk counterparts. Sensitivity and specificity in the studies were around 55% and 70%, respectively, meaning the tool is better at ruling out risk than ruling it in. The authors noted, “Half of the clinicians rated the OxMIS as providing an accurate representation of suicide risk, with a moderate correlation between the OxMIS and their clinical judgment of risk (r s (58) = 0.51, p < 0.001).” They reported that OxMIS was feasible to implement in routine clinical workflow.

CARLAT TAKE
This meta-analysis incorporated limited evidence and offers lukewarm support for OxMIS. For patients with bipolar disorder or schizophrenia spectrum disorders, OxMIS is more helpful for determining who is not at elevated suicide risk—but when it does determine a patient is high risk, that deserves consideration. It’s a free online tool with evidence to support it; so, should we add it to our armamentarium? For now, consider it a research-supported supplement for good clinical judgment and not a replacement for your own risk assessment.