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. 2020 Dec 2;7(1):e2.
doi: 10.1192/bjo.2020.123.

Accuracy of individual and combined risk-scale items in the prediction of repetition of self-harm: multicentre prospective cohort study

Anna Kathryn Taylor  1 , Sarah Steeg  1 , Leah Quinlivan  2 , David Gunnell  3 , Keith Hawton  4 , Nav Kapur  2
Affiliations

Accuracy of individual and combined risk-scale items in the prediction of repetition of self-harm: multicentre prospective cohort study

Anna Kathryn Taylor et al. BJPsych Open. .

Abstract

Background: Individuals attending emergency departments following self-harm have increased risks of future self-harm. Despite the common use of risk scales in self-harm assessment, there is growing evidence that combinations of risk factors do not accurately identify those at greatest risk of further self-harm and suicide.

Aims: To evaluate and compare predictive accuracy in prediction of repeat self-harm from clinician and patient ratings of risk, individual risk-scale items and a scale constructed with top-performing items.

Method: We conducted secondary analysis of data from a five-hospital multicentre prospective cohort study of participants referred to psychiatric liaison services following self-harm. We tested predictive utility of items from five risk scales: Manchester Self-Harm Rule, ReACT Self-Harm Rule, SAD PERSONS, Modified SAD PERSONS, Barratt Impulsiveness Scale and clinician and patient risk estimates. Area under the curve (AUC), sensitivity, specificity, predictive values and likelihood ratios were used to evaluate predictive accuracy, with sensitivity analyses using classification-tree regression.

Results: A total of 483 self-harm episodes were included, and 145 (30%) were followed by a repeat presentation within 6 months. AUC of individual items ranged from 0.43-0.65. Combining best performing items resulted in an AUC of 0.56. Some individual items outperformed the scale they originated from; no items were superior to clinician or patient risk estimations.

Conclusions: No individual or combination of items outperformed patients' or clinicians' ratings. This suggests there are limitations to combining risk factors to predict risk of self-harm repetition. Risk scales should have little role in the management of people who have self-harmed.

Keywords: Risk assessment; rating scales; self-harm; statistical methodology; suicide.

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Conflict of interest statement

D.G., K.H. and N.K. are members of the Department of Health's (England) National Suicide Prevention Strategy Advisory Group. N.K. chaired the National Institute for Health and Care Excellence (NICE) guideline development group for the longer-term management of self-harm and the NICE Topic Expert Group (which developed the quality standards for self-harm services). He is currently chair of the updated NICE guideline for Depression. K.H. and D.G. are Emeritus NIHR Senior Investigators. K.H. is also supported by the Oxford Health NHS Foundation Trust and N.K. by the Manchester Mental Health and Social Care Trust.

ICMJE forms are in the supplementary material, available online at https://doi.org/10.1192/bjo.2020.123.

Figures

Fig. 1
Fig. 1
Area under the curve (AUC) and 95% confidence intervals for the Manchester Self-Harm Rule, ReACT rule and the patient and clinician global scales.
Fig. 2
Fig. 2
Area under the curve (AUC) and 95% confidence intervals for the SAD PERSONS/Modified SAD PERSONS scales and the patient and clinician global scales.
Fig. 3
Fig. 3
Area under the curve (AUC) and 95% confidence intervals for the Barratt Impulsiveness Scale and the patient and clinician global scales.
See this image and copyright information in PMC

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