Article Text

Which are the most useful scales for predicting repeat self-harm? A systematic review evaluating risk scales using measures of diagnostic accuracy
  1. L Quinlivan1,
  2. J Cooper1,
  3. L Davies2,
  4. K Hawton3,
  5. D Gunnell4,
  6. N Kapur1,5
  1. 1Centre for Mental Health and Safety, University of Manchester, Manchester, UK
  2. 2Institute of Population Health, University of Manchester, Manchester, UK
  3. 3Department of Psychiatry, Centre for Suicide Research, University, Warneford Hospital, Oxford, UK
  4. 4School of Social and Community Medicine, University of Bristol, Bristol, UK
  5. 5Manchester Mental Health and Social Care Trust, Manchester, UK
  1. Correspondence to Dr L Quinlivan; leah.quinlivan{at}manchester.ac.uk

Abstract

Objectives The aims of this review were to calculate the diagnostic accuracy statistics of risk scales following self-harm and consider which might be the most useful scales in clinical practice.

Design Systematic review.

Methods We based our search terms on those used in the systematic reviews carried out for the National Institute for Health and Care Excellence self-harm guidelines (2012) and evidence update (2013), and updated the searches through to February 2015 (CINAHL, EMBASE, MEDLINE, and PsychINFO). Methodological quality was assessed and three reviewers extracted data independently. We limited our analysis to cohort studies in adults using the outcome of repeat self-harm or attempted suicide. We calculated diagnostic accuracy statistics including measures of global accuracy. Statistical pooling was not possible due to heterogeneity.

Results The eight papers included in the final analysis varied widely according to methodological quality and the content of scales employed. Overall, sensitivity of scales ranged from 6% (95% CI 5% to 6%) to 97% (CI 95% 94% to 98%). The positive predictive value (PPV) ranged from 5% (95% CI 3% to 9%) to 84% (95% CI 80% to 87%). The diagnostic OR ranged from 1.01 (95% CI 0.434 to 2.5) to 16.3 (95%CI 12.5 to 21.4). Scales with high sensitivity tended to have low PPVs.

Conclusions It is difficult to be certain which, if any, are the most useful scales for self-harm risk assessment. No scales perform sufficiently well so as to be recommended for routine clinical use. Further robust prospective studies are warranted to evaluate risk scales following an episode of self-harm. Diagnostic accuracy statistics should be considered in relation to the specific service needs, and scales should only be used as an adjunct to assessment.

  • PSYCHIATRY
  • PUBLIC HEALTH
  • Diagnostic accuracy
  • HEALTH SERVICES ADMINISTRATION & MANAGEMENT

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

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