Predicting suicide following self-harm: A systematic review of risk factors and risk scales

Chan, M. K.Y., Bhatti, H., Meader, N., Stockton, S., Evans, J., O'Connor, R. , Kapur, N. and Kendall, T. (2016) Predicting suicide following self-harm: A systematic review of risk factors and risk scales. British Journal of Psychiatry, 209(4), pp. 277-283. (doi: 10.1192/bjp.bp.115.170050) (PMID:27340111)

Abstract

Background: Suicide and self-harm are major public health problems. People with a history of self-harm are at a far greater risk of suicide than the general population. However, the relationship between self-harm and suicide is complex. We have undertaken the first systematic review and meta-analysis of prospective studies of risk factors and risk assessment scales to predict suicide following self-harm, undertaken as part of the development of the National Institute for Health and Care Excellence (NICE) guideline. Methods: For this systematic review, Embase, MEDLINE, PsycINFO and CINAHL were searched for English-language prospective cohort studies of populations who had selfharmed. For the review of risk scales we also included studies examining the risk of suicide in people under specialist mental health care, in order to broaden the scope of the review and increase the number of studies considered. Differences in predictive accuracy between populations were examined where applicable. Results: Twelve studies on risk factors and 7 studies on risk scales were included. Four risk factors emerged from the meta-analysis, with robust effect sizes that showed little change when adjusted for important potential confounders. These included: previous episodes of selfharm (HR 1.68, 95% CI 1.38 to 2.05, K=4), suicidal intent (HR 2.7, 95% CI 1.91 to 3.81, K=3), physical health problems (HR 1.99, 95% CI 1.16-3.43, K=3) and male gender (HR 2.05, 95% CI 1.70 to 2.46, K=5). The included studies evaluated only 3 risk scales (Beck Hopelessness Scale [BHS], Suicide Intent Scale [SIS] and Scale for Suicide Ideation [SSI]). Where meta-analyses were possible (BHS, SIS), the analysis was based on sparse data and a high heterogeneity was observed. The positive predictive values ranged from 1.3% to 16.7%. Interpretation: Four factors indicated an increased risk of suicide following self-harm. Although of interest, these are unlikely to be of much practical use because they are comparatively common in clinical populations. No scales have sufficient evidence to support their use in predicting suicide. The use of these scales, or an over-reliance on the identification of risk factors in clinical practice, may provide false reassurance and are, therefore, potentially dangerous. Comprehensive psychosocial assessments of the risks and needs that are specific to the individual should be central to the management of people who have self-harmed.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: O'Connor, Professor Rory
• Authors: Chan, M. K.Y., Bhatti, H., Meader, N., Stockton, S., Evans, J., O'Connor, R., Kapur, N., and Kendall, T.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Mental Health and Wellbeing
• Journal Name: British Journal of Psychiatry
• Publisher: Royal College of Psychiatrists
• ISSN: 0007-1250
• ISSN (Online): 1472-1465
• Published Online: 23 June 2016
• Copyright Holders: Copyright © 2016 Royal College of Psychiatrists
• First Published: First published in British Journal of Psychiatry 209(4): 277-283
• Publisher Policy: Reproduced in accordance with the copyright policy of the publisher