Predictive accuracy of risk scales following self-harmCitation formats

  • External authors:
  • Jayne Cooper
  • Declan Meehan
  • Damien Longson
  • John Potokar
  • Tom Hulme
  • Jennifer Marsden
  • Fiona Brand
  • Kezia Lange
  • Elena Riseborough
  • Lisa Page
  • Chris Metcalfe
  • Rory C O'Connor
  • Keith Hawton
  • David Gunnell

Standard

Predictive accuracy of risk scales following self-harm : Multicentre, prospective cohort study. / Quinlivan, Leah; Cooper, Jayne; Meehan, Declan; Longson, Damien; Potokar, John; Hulme, Tom; Marsden, Jennifer ; Brand, Fiona ; Lange, Kezia; Riseborough, Elena ; Page, Lisa; Metcalfe, Chris; Davies, Linda; O'Connor, Rory C; Hawton, Keith; Gunnell, David; Kapur, Nav.

In: The British Journal of Psychiatry, Vol. 210, No. 6, 02.01.2018, p. 429-436.

Research output: Contribution to journalArticlepeer-review

Harvard

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, RC, Hawton, K, Gunnell, D & Kapur, N 2018, 'Predictive accuracy of risk scales following self-harm: Multicentre, prospective cohort study', The British Journal of Psychiatry, vol. 210, no. 6, pp. 429-436. https://doi.org/10.1192/bjp.bp.116.189993

APA

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. C., Hawton, K., Gunnell, D., & Kapur, N. (2018). Predictive accuracy of risk scales following self-harm: Multicentre, prospective cohort study. The British Journal of Psychiatry, 210(6), 429-436. https://doi.org/10.1192/bjp.bp.116.189993

Vancouver

Quinlivan L, Cooper J, Meehan D, Longson D, Potokar J, Hulme T et al. Predictive accuracy of risk scales following self-harm: Multicentre, prospective cohort study. The British Journal of Psychiatry. 2018 Jan 2;210(6):429-436. https://doi.org/10.1192/bjp.bp.116.189993

Author

Quinlivan, Leah ; Cooper, Jayne ; Meehan, Declan ; Longson, Damien ; Potokar, John ; Hulme, Tom ; Marsden, Jennifer ; Brand, Fiona ; Lange, Kezia ; Riseborough, Elena ; Page, Lisa ; Metcalfe, Chris ; Davies, Linda ; O'Connor, Rory C ; Hawton, Keith ; Gunnell, David ; Kapur, Nav. / Predictive accuracy of risk scales following self-harm : Multicentre, prospective cohort study. In: The British Journal of Psychiatry. 2018 ; Vol. 210, No. 6. pp. 429-436.

Bibtex

@article{165fa5fbc6d84f00a4dfa4a4cf8a3c4f,
title = "Predictive accuracy of risk scales following self-harm: Multicentre, prospective cohort study",
abstract = "Background: Scales are widely used in psychiatric assessments following self-harm. Robust evidence from prospective diagnostic accuracy cohort studies 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 Impulsivity Scale); and patient and clinician estimations of risk in identifying patients who repeat self-harm within six 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. Area under the curve (AUC) was used to determine optimal cut-offs and compare global accuracy.Results: 483 episodes of self-harm were included in the study. There was a repeat episode in 145 of these (30%) within six months. 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. Area under the curve 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 scale. The remaining scales performed significantly worse than clinician and patient estimates of risk (p<0.001).Conclusion: 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. ",
keywords = "Self-harm, suicidal behaviour, Emergency Services, Psychiatric, Diagnostic accuracy, Risk scales, Health services , Psychiatry ",
author = "Leah Quinlivan and Jayne Cooper and Declan Meehan and Damien Longson and John Potokar and Tom Hulme and Jennifer Marsden and Fiona Brand and Kezia Lange and Elena Riseborough and Lisa Page and Chris Metcalfe and Linda Davies and O'Connor, {Rory C} and Keith Hawton and David Gunnell and Nav Kapur",
year = "2018",
month = jan,
day = "2",
doi = "10.1192/bjp.bp.116.189993",
language = "English",
volume = "210",
pages = "429--436",
journal = "British Journal of Psychiatry",
issn = "0007-1250",
publisher = "Royal College of Psychiatrists",
number = "6",

}

RIS

TY - JOUR

T1 - Predictive accuracy of risk scales following self-harm

T2 - Multicentre, prospective cohort study

AU - Quinlivan, Leah

AU - Cooper, Jayne

AU - Meehan, Declan

AU - Longson, Damien

AU - Potokar, John

AU - Hulme, Tom

AU - Marsden, Jennifer

AU - Brand, Fiona

AU - Lange, Kezia

AU - Riseborough, Elena

AU - Page, Lisa

AU - Metcalfe, Chris

AU - Davies, Linda

AU - O'Connor, Rory C

AU - Hawton, Keith

AU - Gunnell, David

AU - Kapur, Nav

PY - 2018/1/2

Y1 - 2018/1/2

N2 - Background: Scales are widely used in psychiatric assessments following self-harm. Robust evidence from prospective diagnostic accuracy cohort studies 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 Impulsivity Scale); and patient and clinician estimations of risk in identifying patients who repeat self-harm within six 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. Area under the curve (AUC) was used to determine optimal cut-offs and compare global accuracy.Results: 483 episodes of self-harm were included in the study. There was a repeat episode in 145 of these (30%) within six months. 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. Area under the curve 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 scale. The remaining scales performed significantly worse than clinician and patient estimates of risk (p<0.001).Conclusion: 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.

AB - Background: Scales are widely used in psychiatric assessments following self-harm. Robust evidence from prospective diagnostic accuracy cohort studies 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 Impulsivity Scale); and patient and clinician estimations of risk in identifying patients who repeat self-harm within six 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. Area under the curve (AUC) was used to determine optimal cut-offs and compare global accuracy.Results: 483 episodes of self-harm were included in the study. There was a repeat episode in 145 of these (30%) within six months. 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. Area under the curve 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 scale. The remaining scales performed significantly worse than clinician and patient estimates of risk (p<0.001).Conclusion: 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.

KW - Self-harm

KW - suicidal behaviour

KW - Emergency Services, Psychiatric

KW - Diagnostic accuracy

KW - Risk scales

KW - Health services

KW - Psychiatry

U2 - 10.1192/bjp.bp.116.189993

DO - 10.1192/bjp.bp.116.189993

M3 - Article

C2 - 28302702

VL - 210

SP - 429

EP - 436

JO - British Journal of Psychiatry

JF - British Journal of Psychiatry

SN - 0007-1250

IS - 6

ER -