Predictive accuracy of risk scales following self-harm: multicentre, prospective cohort study

Quinlivan, L. et al. (2017) Predictive accuracy of risk scales following self-harm: multicentre, prospective cohort study. British Journal of Psychiatry, 210(6), pp. 429-436. (doi: 10.1192/bjp.bp.116.189993) (PMID:28302702) (PMCID:PMC5451643)

Abstract

Background: Scales are widely used in psychiatric assessments following self-harm. Robust evidence for their diagnostic use is lacking. Aims: To evaluate the performance of risk scales (Manchester Self-Harm Rule, ReACT Self-Harm Rule, SAD PERSONS scale, Modified SAD PERSONS scale, Barratt Impulsiveness Scale); and patient and clinician estimates of risk in identifying patients who repeat self-harm within 6 months. Method: A multisite prospective cohort study was conducted of adults aged 18 years and over referred to liaison psychiatry services following self-harm. Scale a priori cut-offs were evaluated using diagnostic accuracy statistics. The area under the curve (AUC) was used to determine optimal cut-offs and compare global accuracy. Results: In total, 483 episodes of self-harm were included in the study. The episode-based 6-month repetition rate was 30% (n = 145). Sensitivity ranged from 1% (95% CI 0–5) for the SAD PERSONS scale, to 97% (95% CI 93–99) for the Manchester Self-Harm Rule. Positive predictive values ranged from 13% (95% CI 2–47) for the Modified SAD PERSONS Scale to 47% (95% CI 41–53) for the clinician assessment of risk. The AUC ranged from 0.55 (95% CI 0.50–0.61) for the SAD PERSONS scale to 0.74 (95% CI 0.69–0.79) for the clinician global scale. The remaining scales performed significantly worse than clinician and patient estimates of risk (P<0.001). Conclusions: Risk scales following self-harm have limited clinical utility and may waste valuable resources. Most scales performed no better than clinician or patient ratings of risk. Some performed considerably worse. Positive predictive values were modest. In line with national guidelines, risk scales should not be used to determine patient management or predict self-harm.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: O'Connor, Professor Rory
• Authors: Quinlivan, L., Cooper, J., Meehan, D., Longson, D., Potokar, J., Hulme, T., Marsden, J., Brand, F., Lange, K., Riseborough, E., Page, L., Metcalfe, C., Davies, L., O'Connor, R., Hawton, K., Gunnell, D., and Kapur, N.
• 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: 16 March 2017
• Copyright Holders: Copyright © 2017 The Authors
• First Published: First published in British Journal of Psychiatry 210(6):429-436
• Publisher Policy: Reproduced under a Creative Commons License