Scale operational factors
| Instrument | Purpose of instrument | Cost | Description | Time (min) | Copyright | Administration | Training | Study reference | Original scale reference |
|---|---|---|---|---|---|---|---|---|---|
| The Manchester Self-Harm Rule | Risk-stratification model for use with ED staff in the assessment of self-harm to discriminate between patients and higher vs lower risk of repetition or subsequent suicide by 6 months | Free | 4 screening items, dichotomous answers (history of self-harm, prior psychiatric treatment, benzodiazepine overdose, current psychiatric treatment) (1=present, 0=absent), positive answer is a positive result | 5 | No | Paper and pen | Limited training necessary | Cooper et al27 | Cooper et al27 |
| The ReACT Self-Harm Rule | Screening tool to identify patients at higher risk of repeat self-harm suicide within 6 months of ED self-harm presentation | Free | 4 items (recent self-harm (in the past year), Alone of homeless (living status), cutting used as a method of harm, and treatment for a current psychiatric disorder), presence of one or more of these items classifies patient as at higher risk of repeat self-harm/suicide within 6 months | 5 | No | Paper and pen | Limited training necessary | Steeg et al36 | Steeg et al36 |
| The RESH Self-Harm tool | Designed to assist clinicians in clinical management of self-harm patients | Free | 4 main items with an assigned weight: number of prior episodes (0, 1, 2, 3, 4, 5, 6 or more), time between episodes (1–60 days, 61 days to 12 months, > 12 months), psychiatric diagnosis in the last 12 months (substance misuse disorder, depression, anxiety, eating disorder, personality disorder), and psychiatric stay in the last 12 months. The RESH scale was constructed using a weighted scoring algorithm based on the log ORs based on 0 to 20. It has five cut-off points ranging from low-risk to high-risk that can be applied to different interventions | Unknown | No | Paper and Pen | Unknown | Spittal et al14 | Spittal et al14 |
| The Global Severity Index (GSI) | The GSI symptom scale is a component of the Brief Symptom Inventory (BSI). Also a global indicator, the Symptom Checklist-90-Revised (SCL-90-R) is ‘designed to help quantify a patients severity-of-illness and provides a single composite score for measuring the outcome of a treatment programme based on reducing symptom severity’ (Pearson Assessments) | £118.32 per 50 answer sheets with test items, 50 profile forms and 2 worksheets (£935+vat for 500) | 53-item self-report on 5-point rating scale. 9 symptom dimensions (somatisation, Obsessive-compulsive, Interpersonal sensitivity, Depression, Anxiety, Hostility, Phobic Anxiety, Paranoid Ideation, Psychoticism) Global Indices (Global severity index, Positive Symptom Distress Index, Positive Symptom total). Also a component of the 90-item SCL-90-R (12–15 min to complete) | 8–10 | Pearson Assessments | Q Local Software, Mail-in scoring service, Hand scoring, or optimal Scan Scoring | B, Q1, Q2 level | Randall et al15 | Derogitis and Melisaratos 37 |
| The SAD PERSONS scale | Educational tool for medical students to determine suicide risk | Free | 10-item mnemonic consisting of risk factors based on literature review (male sex, age, depression, previous attempt, excess alcohol or substance abuse, rational thinking loss, social supports lacking, organised plan, no spouse, sickness). Items scored 1 if present, 0 if absent. Cut-off points: 3 categories of suicide risk, low, moderate, and high (0–4, 5–6 and 7–10, respectively) | 5–10 | No | Paper and pen | Limited training necessary | Bolton et al34 | Patterson et al38 |
| The Modified SAD PERSONS | Suicide assessment in the ED | 10-item scale. Modified SAD PERSONS by adding five additional criteria (feelings of hopelessness, history of psychiatric care, drug addiction, a ‘serious’ attempt, and affirmative or ambivalent answers when questioned about future intent regarding suicide. Four scale items are weighted with scores of 2 to give a total possible score of 14. Cut-off points: low (0–5), moderate (6–8), and high (9–14) | 5–10 | No | Paper and pen | Limited training necessary | Bolton et al34 | Hockberger and Rothstein39 | |
| The Barratt Impulsivity Scale | Designed to assess the personality trait of impulsiveness | Free | 30 items based on personality. Self-report. Responses scored on a 4-point likert scale. Responses summed to total score | 10 | No | Paper and pen | None | Randall et al15 | Patton et al40 |
| The Drug Abuse Screening Test | Designed to identify patients who are abusing drugs, also to provide a quantitative index score if the degree of problems related to drug use and misuse | Free | 28-items self-report Responses are dichotomous (1=yes, 0=no), except for items 4, 5, and 7 which are reverse coded. The scale is unidimensional with a total score calculated from summing all the items that are positive in relation to increased drug use. Cut-off scores of six to 11 are used for identifying patients with drug abuse/ misuse problems, whereas of 16 or above is considered as severe drug abuse or dependency | 5 | No | Paper and Pen | Adherence to instructions for administration and scoring provided with the scale | Randall et al15 | Skinner41 |
| The Suicide Assessment Scale | Designed to be sensitivity to change in suicidality over time and in treatment | Free | 20 items, on a 0–4 likert scale summed to arrive at a maximum score of 80. Five main areas covered: (affect (5 items), bodily states (5 items), control and coping (5 items), emotional reactivity, suicidal thoughts and behaviour (5 items). Clinician and self-report versions available | >30=high risk | No | Paper and pen | Instructions available | Waern et al33 | Stanley et al42 Niméus et al43 |
| Edinburgh Risk of Repetition Scale | Designed to identify patients at risk of repeat self-harm | Free | 11 items (previous self-harm, personality disorder, alcohol, previous psychiatric care, unemployment, social class, drug abuse, criminal record, violence, age (25–54), civil status (single, divorced, separated). Each positive item, scored as 1, total ranges from 0–11 | Men >8=high risk Women >6=high risk | No | Paper and Pen | None | Carter et al29 | Kreitman and Foster44 |
| Söderjukhuset Self-Harm Rule | Designed to identify patients at risk of repeat self-harm | Free | 4 items (gender, current psychiatric treatment, previous self-harm, antidepressant treatment) | Regression model: risk above 0.14 predicted to be repeater | No | Paper and pen and calculator | None, but familiarity with regression models and calculation necessary | Bilén et al35 | Bilén et al35 |
ED, emergency department; RESH, Repeated Episodes of Self-Ham score.