Accuracy of risk scales for predicting repeat self-harm and suicide: a multicentre, population-level cohort study using routine clinical data
Abstract Background 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...
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doaj-3b2e1f5d9b6d437587306953fe724c392020-11-25T01:14:47ZengBMCBMC Psychiatry1471-244X2018-04-0118111110.1186/s12888-018-1693-zAccuracy of risk scales for predicting repeat self-harm and suicide: a multicentre, population-level cohort study using routine clinical dataSarah Steeg0Leah Quinlivan1Rebecca Nowland2Robert Carroll3Deborah Casey4Caroline Clements5Jayne Cooper6Linda Davies7Duleeka Knipe8Jennifer Ness9Rory C. O’Connor10Keith Hawton11David Gunnell12Nav Kapur13Centre for Mental Health and Safety, Manchester Academic Health Science Centre, University of ManchesterCentre for Mental Health and Safety, Manchester Academic Health Science Centre, University of ManchesterCentre for Mental Health and Safety, Manchester Academic Health Science Centre, University of ManchesterPopulation Health Sciences, Bristol Medical School, University of BristolCentre for Suicide Research, University of Oxford Department of Psychiatry, Warneford HospitalCentre for Mental Health and Safety, Manchester Academic Health Science Centre, University of ManchesterCentre for Mental Health and Safety, Manchester Academic Health Science Centre, University of ManchesterInstitute of Population Health, University of ManchesterPopulation Health Sciences, Bristol Medical School, University of BristolCentre for Self-harm and Suicide Prevention Research, Derbyshire Healthcare NHS Foundation TrustSuicidal Behaviour Research Laboratory, Institute of Health and Wellbeing, University of GlasgowCentre for Suicide Research, University of Oxford Department of Psychiatry, Warneford HospitalPopulation Health Sciences, Bristol Medical School, University of BristolCentre for Mental Health and Safety, Manchester Academic Health Science Centre, University of ManchesterAbstract Background 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. Method 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. Results 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. Conclusions 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.http://link.springer.com/article/10.1186/s12888-018-1693-zSelf-harmSuicideRisk factorsClassificationOutcome |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
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 |
spellingShingle |
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 Accuracy of risk scales for predicting repeat self-harm and suicide: a multicentre, population-level cohort study using routine clinical data BMC Psychiatry Self-harm Suicide Risk factors Classification Outcome |
author_facet |
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 |
author_sort |
Sarah Steeg |
title |
Accuracy of risk scales for predicting repeat self-harm and suicide: a multicentre, population-level cohort study using routine clinical data |
title_short |
Accuracy of risk scales for predicting repeat self-harm and suicide: a multicentre, population-level cohort study using routine clinical data |
title_full |
Accuracy of risk scales for predicting repeat self-harm and suicide: a multicentre, population-level cohort study using routine clinical data |
title_fullStr |
Accuracy of risk scales for predicting repeat self-harm and suicide: a multicentre, population-level cohort study using routine clinical data |
title_full_unstemmed |
Accuracy of risk scales for predicting repeat self-harm and suicide: a multicentre, population-level cohort study using routine clinical data |
title_sort |
accuracy of risk scales for predicting repeat self-harm and suicide: a multicentre, population-level cohort study using routine clinical data |
publisher |
BMC |
series |
BMC Psychiatry |
issn |
1471-244X |
publishDate |
2018-04-01 |
description |
Abstract Background 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. Method 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. Results 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. Conclusions 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. |
topic |
Self-harm Suicide Risk factors Classification Outcome |
url |
http://link.springer.com/article/10.1186/s12888-018-1693-z |
work_keys_str_mv |
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