La recherche de facteurs de risque suicidaire permet de définir des populations à risque. Elle ne donne pas au clinicien d’informations sur l’éventualité imminente d’un passage à l’acte. Des instruments psychométriques cherchent à aider le thérapeute dans cette démarche. Parmi ceux-ci, on peut citer l’échelle d’évaluation du risque suicidaire RSD. Son inclusion dans une étude de prévention des récidives dépressives à long terme montre une validité concourante satisfaisante de la RSD avec les items « suicide » de la MADRS (ρ = 0,79 ; p = 0,0001) et de l’échelle Hamilton-dépression (ρ = 0,70 ; p = 0,0001) et moins satisfaisante avec le degré de dépression évalué par le score global de la MADRS (ρ = 0,40 ; p = 0,0001). Le suivi à court terme sous traitement démontre la sensibilité de la RSD qui s’améliore plus rapidement que la MADRS. Ceci pose certaines questions par rapport à l’augmentation du risque suicidaire décrite dans la littérature pour certains antidépresseurs. Le suivi à moyen terme permet de tester la validité prédictive de la RSD. Il confirme un niveau de risque suicidaire aggravé à partir d’un score de 7, avec le décès par suicide de 2 patients parmi les 15 qui avaient lors de leur inclusion un score entre 7 et 10 à la RSD. En revanche, aucun suicide, ni aucune tentative de passage à l’acte n’ont été à déplorer, sur les 18 mois de suivi, dans le groupe témoin des 88 patients pour lesquels la RSD était inférieure ou égale à 6 à J0 (p = 0,02 au test exact de Fisher).

Introduction. A part (60 % to 70 %) of those who are going to act out their suicide consult a doctor the month before. Studies have shown the need to improve the practitioner’s capacity to diagnose depression. The assessment of the suicidal risk is crucial. The search for suicidal risk factors helps to define the populations at risk. However, it doesn’t provide information concerning the possibility of acting out in the short term. And how does one react when faced with those who do not present any of the risk factors ? Psychometric instruments attempt to help the therapist in his/her reasoning. Suicidal risk assessment. Among them, the suicidal risk assessment scale RSD should be mentioned. Its objective is to estimate the seriousness of the suicidal risk, with 11 levels. It is built around a possible will to commit suicide rather than a single assessment of the frequency of suicidal ideas. Its construction in hierarchical order permits the progressive assessment of the suicidal risk, in the form of a semi-structured interview. Hence, the suicidal risk assessment scale RSD looks for the existence of death wishes (levels 1-2), of suicide ideations and its frequency (levels 3-4-5), and of a passive desire to die (level 6). Level 7 shows the onset of a decision making process, except that the patient is still inhibited by various important factors in his/her life. More often, the fear of inflicting immense suffering to his/her loved ones or for religious beliefs, is found. From level 8, determination has made way to hesitation. An active death wish exists, and although the plan remains undefined, the act is decided on. At level 9 the methods of application are developed and a plan is established. The ultimate level exists when there is a start in the preparation of the act of suicide (level 10). This hierarchical order has been confirmed by some epidemiological studies. Method. The inclusion of the suicidal risk assessment scale RSD in a double-blind, placebo-controlled study, which tested the efficacy of fluvoxamine in reducing the risk of recurrence of depression over 18 months, appears of particular interest. In this multicentre study, patients of both sexes were included, aged between 18 and 70 years, presenting a major depressive episode with a MADRS equal to a minimum of 25, and having had a minimum of two episodes of major depression within the last five years. Results. The resulting analysis carried out on 103 patients showed a satisfactory concurrent validity between the suicidal risk assessment scale RSD and the items « suicide » of the MADRS (ρ = 0.79 ; p = 0.0001) and the Hamilton Depression Scale (ρ = 0.70 ; p = 0.0001), and fairly satisfactory concurrent validity with the depression degree assessed by the MADRS overall score (ρ = 0.40; p = 0.0001). The short-term follow-up under treatment revealed enhanced sensitivity of the RSD versus the MADRS. The improvement in suicidal risk, assessed by the RSD, was faster than the improvement in depression, which is interesting from a clinical point of view. The medium-term follow-up tested the predictive validity of RSD and confirmed a greater level of suicidal risk from a score of 7 on the RSD, with the death by suicide of 2 subjects among the 15 who exhibited a score between 7 and 10 on the RSD on inclusion. On the other hand, no acting out, no attempted suicides, and no suicides were noted in the group of 88 subjects whose RSD was lower or equal to 6 on inclusion (p = 0.02 using Fisher’s exact test). Conclusion. Thus, the RSD appears of interest, from a clinical point of view, by providing a ­diagnostic, or a scientific approach.