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


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

In This Article


The letters were collected between April and September 2002. The two suicide (n = 40) and control (n = 40) groups were similar in terms of mean age (respectively 38.0 and 37.7), sex (male 12 and 15) and left hand status.[3,1] The mean MADRS score in the control healthy group was 6.72 ± 3.7.

Classification of the letters as suicide or controls by the graphologists and internists is presented in Table 1 . All 80 letters were included in the ITT analysis. A discordance between the two graphologists was observed in 12 cases, but the consensus discussion finally led to correct diagnosis in eight cases. In brief, the graphological diagnosis had a sensitivity of 80% (IC 66-90), a specificity of 82% (IC 95%: 67-91), a positive predictive value of 82% (IC 95%: 67-91) and a negative predictive value of 80% (IC 95%: 66-90). Their final diagnosis was statistically superior to a chance distribution (α2 = 15.6, df = 2, p < 0.001). For the internists, the results were sensitivity 0.67, specificity 0.85, positive predictive value 0.82 and negative predictive value 0.72, also statistically different to chance (χ2 = 12.2, df = 2, p = 0.005). There was no statistical difference regarding the accuracy of the diagnosis between the graphologists and internists (p = 0.45).

For the per-protocol (PP) analysis, 12 letters expressing sadness were excluded: 10 from the suicide group and two from the control group. Eleven of these were classified as 'suicide' by both teams of evaluators in the ITT analysis. In the PP analysis, the characteristics of the graphological test for graphologists and internists after confrontation were, respectively, sensitivity 73 and 53%, specificity 88 and 89%, positive predictive value 81 and 80%, negative predictive value 82 and 71%. Both the graphologists and the internists remained significantly different to chance in the PP analysis (p < 0.001 for both evaluator groups). After initial evaluation of the 80 letters, the two graphologists disagreed on the diagnosis of 12 letters; the consensus session led to a final correct diagnosis in eight letters. For the internists, diverging opinions were observed in 22 letters and a consensus was obtained with a final correct diagnosis in 14.


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