Accuracy of risk scales for predicting repeat self-harm and suicide: a multicentre, population-level cohort study using routine clinical data

Steeg, S. et al. (2018) Accuracy of risk scales for predicting repeat self-harm and suicide: a multicentre, population-level cohort study using routine clinical data. BMC Psychiatry, 18, 113. (doi: 10.1186/s12888-018-1693-z) (PMID:29699523) (PMCID:PMC5921289)

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.

• Item Type: Articles
• Additional Information: This paper presents independent research funded by the National Institute of Health Research (NIHR) under its Programme Grants for Applied Research Programme (Grant Reference Number RP-PG-0610-10026).
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: O'Connor, Professor Rory
• Authors: Steeg, S., Quinlivan, L., Nowland, R., Carroll, R., Casey, D., Clements, C., Cooper, J., Davies, L., Knipe, D., Ness, J., O'Connor, R. C., 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: BMC Psychiatry
• Publisher: BioMed Central
• ISSN: 1471-244X
• ISSN (Online): 1471-244X
• Copyright Holders: Copyright © 2018 The Authors
• First Published: First published in BMC Psychiatry 18:113
• Publisher Policy: Reproduced under a Creative Commons License