Graphology for the Diagnosis of Suicide Attempts: a Blind Proof of Principle Controlled Study

S. Mouly; I. Mahé; K. Champion; C. Bertin; P. Popper; D. De Noblet; J. F. Bergmann

Disclosures

Int J Clin Pract. 2007;61(3):411-415. 

In This Article

Summary and Introduction

Summary

To evaluate the ability of two graphologists and two practising internists not trained in graphology to differentiate letters written by subjects who have attempted to commit suicide by self-poisoning and healthy volunteers, we performed a maximal blind controlled study vs. healthy volunteers. Forty fully recovered patients who had attempted to commit suicide and 40 healthy volunteers wrote and signed a short letter or story not related to the parasuicide or their mental health status. The evaluators classified the 80 letters as 'suicide' or 'no suicide' in an intention-to-treat analysis. Letters expressing sadness were subsequently excluded for a per-protocol analysis. Correct diagnosis of suicide and of healthy controls was made in, respectively, 32 of 40 and 33 of 40 letters by the graphologists and in 27 of 40 and 34 of 40 letters by the internists. After the exclusion of 12 letters expressing sadness, the sensitivity, specificity, positive predictive value and negative predictive value were, respectively, 73, 88, 81 and 82% for the graphologists and 53, 89, 80 and 71% for the internists. Both classified the letters with significantly more effectiveness than chance (p < 0.001) with no statistically significant difference between the two groups of evaluators. We concluded that graphological analysis is able to differentiate letters written by patients who attempt suicide from those written by healthy controls. This technique shows an acceptable degree of accuracy and could therefore become an additional discharge or decision-making tool in Psychiatry or Internal Medicine.

Introduction

Suicide is a major public health problem, but there is little evidence regarding the effectiveness of prevention programmes.[1] Predictive evaluation of the risk of suicide is difficult both in general practice[2] and in psychiatric units.[3] The level of self-control in a patient presenting risk factors for suicide cannot be evaluated using a single test,[4] but it is nevertheless important that this should be approached for therapeutic decision-making, hospitalisation or discharge.

Medical graphology is a subjective method of handwriting analysis for evaluation of personality.[5] But only few psychological characteristics such as psychoses, psychosomatic symptoms or extraversions[6] have been correlated with graphological characteristics. Because of the poor methodology of these studies, it is not clear whether graphology is able to determine the psychological profile of patients.[7] Graphologists claim to be able to determine pathological behaviour such as hysteria or depression by the simple analysis of a single 'neutral' letter from patients and to be able to exclude these diagnoses in a healthy control population. But the sensitivity and specificity of graphology in the diagnosis of psychiatric diseases have never been properly evaluated, in particular because of the difficulty in obtaining a definitive positive diagnosis in patients and excluding such a diagnosis in healthy controls.[8] For graphologists, handwriting analysis can determine suicidal behaviour before or after a suicide attempt. Letters from patients recovering from a recent suicide attempt are thus a good model for evaluating graphology in a controlled study vs. letters from healthy subjects without a history of suicide. If this method proves to be efficient for a psychiatric diagnosis of suicide, it could be proposed as a part of the clinical evaluation of suicide risk in patients.

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