Title |
Accuracy of risk scales for predicting repeat self-harm and suicide: a multicentre, population-level cohort study using routine clinical data
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Published in |
BMC Psychiatry, April 2018
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DOI | 10.1186/s12888-018-1693-z |
Pubmed ID | |
Authors |
Sarah Steeg, Leah Quinlivan, Rebecca Nowland, Robert Carroll, Deborah Casey, Caroline Clements, Jayne Cooper, Linda Davies, Duleeka Knipe, Jennifer Ness, Rory C. O’Connor, Keith Hawton, David Gunnell, Nav Kapur |
Abstract |
Risk scales are used widely in the management of patients presenting to hospital following self-harm. However, there is evidence that their diagnostic accuracy in predicting repeat self-harm is limited. Their predictive accuracy in population settings, and in identifying those at highest risk of suicide is not known. We compared the predictive accuracy of the Manchester Self-Harm Rule (MSHR), ReACT Self-Harm Rule (ReACT), SAD PERSONS Scale (SPS) and Modified SAD PERSONS Scale (MSPS) in an unselected sample of patients attending hospital following self-harm. Data on 4000 episodes of self-harm presenting to Emergency Departments (ED) between 2010 and 2012 were obtained from four established monitoring systems in England. Episodes were assigned a risk category for each scale and followed up for 6 months. The episode-based repeat rate was 28% (1133/4000) and the incidence of suicide was 0.5% (18/3962). The MSHR and ReACT performed with high sensitivity (98% and 94% respectively) and low specificity (15% and 23%). The SPS and the MSPS performed with relatively low sensitivity (24-29% and 9-12% respectively) and high specificity (76-77% and 90%). The area under the curve was 71% for both MSHR and ReACT, 51% for SPS and 49% for MSPS. Differences in predictive accuracy by subgroup were small. The scales were less accurate at predicting suicide than repeat self-harm. The scales failed to accurately predict repeat self-harm and suicide. The findings support existing clinical guidance not to use risk classification scales alone to determine treatment or predict future risk. |
X Demographics
Geographical breakdown
Country | Count | As % |
---|---|---|
United Kingdom | 141 | 46% |
Spain | 13 | 4% |
Australia | 9 | 3% |
Netherlands | 8 | 3% |
Ireland | 3 | <1% |
Argentina | 3 | <1% |
New Zealand | 2 | <1% |
United States | 2 | <1% |
Canada | 2 | <1% |
Other | 13 | 4% |
Unknown | 111 | 36% |
Demographic breakdown
Type | Count | As % |
---|---|---|
Members of the public | 179 | 58% |
Practitioners (doctors, other healthcare professionals) | 89 | 29% |
Scientists | 38 | 12% |
Science communicators (journalists, bloggers, editors) | 1 | <1% |
Mendeley readers
Geographical breakdown
Country | Count | As % |
---|---|---|
Unknown | 172 | 100% |
Demographic breakdown
Readers by professional status | Count | As % |
---|---|---|
Researcher | 26 | 15% |
Student > Bachelor | 16 | 9% |
Student > Master | 15 | 9% |
Student > Ph. D. Student | 14 | 8% |
Student > Doctoral Student | 10 | 6% |
Other | 33 | 19% |
Unknown | 58 | 34% |
Readers by discipline | Count | As % |
---|---|---|
Psychology | 37 | 22% |
Medicine and Dentistry | 30 | 17% |
Nursing and Health Professions | 15 | 9% |
Neuroscience | 10 | 6% |
Social Sciences | 7 | 4% |
Other | 10 | 6% |
Unknown | 63 | 37% |