@article{ref1,
title="Accuracy of individual and combined risk-scale items in the prediction of repetition of self-harm: multicentre prospective cohort study",
journal="BJPsych open",
year="2020",
author="Taylor, Anna Kathryn and Steeg, Sarah and Quinlivan, Leah and Gunnell, David and Hawton, Keith and Kapur, Nav",
volume="7",
number="1",
pages="e2-e2",
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. <br><br>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. <br><br>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. <br><br>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.<p /> <p>Language: en</p>",
language="en",
issn="2056-4724",
doi="10.1192/bjo.2020.123",
url="http://dx.doi.org/10.1192/bjo.2020.123"
}