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Citation
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Chan MKY, Bhatti H, Meader N, Stockton S, Evans J, O'Connor RC, Kapur N, Kendall T. Br. J. Psychiatry 2016; ePub(ePub): ePub. |
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Abstract
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BACKGROUND: Suicide and self-harm are major public health problems. People with a history of
self-harm are at a far greater risk of suicide than the general population. However, the
relationship between self-harm and suicide is complex. We have undertaken the first
systematic review and meta-analysis of prospective studies of risk factors and risk assessment
scales to predict suicide following self-harm, undertaken as part of the development of the
National Institute for Health and Care Excellence (NICE) guideline.
Methods: For this systematic review, Embase, MEDLINE, PsycINFO and CINAHL were
searched for English-language prospective cohort studies of populations who had selfharmed.
For the review of risk scales we also included studies examining the risk of suicide in
people under specialist mental health care, in order to broaden the scope of the review and
increase the number of studies considered. Differences in predictive accuracy between
populations were examined where applicable.
Results: Twelve studies on risk factors and 7 studies on risk scales were included. Four risk
factors emerged from the meta-analysis, with robust effect sizes that showed little change
when adjusted for important potential confounders. These included: previous episodes of selfharm
(HR 1.68, 95% CI 1.38 to 2.05, K=4), suicidal intent (HR 2.7, 95% CI 1.91 to 3.81,
K=3), physical health problems (HR 1.99, 95% CI 1.16-3.43, K=3) and male gender (HR
2.05, 95% CI 1.70 to 2.46, K=5). The included studies evaluated only 3 risk scales (Beck
Hopelessness Scale [BHS], Suicide Intent Scale [SIS] and Scale for Suicide Ideation [SSI]).
Where meta-analyses were possible (BHS, SIS), the analysis was based on sparse data and a
high heterogeneity was observed. The positive predictive values ranged from 1.3% to 16.7%.
Interpretation: Four factors indicated an increased risk of suicide following self-harm.
Although of interest, these are unlikely to be of much practical use because they are
comparatively common in clinical populations. No scales have sufficient evidence to support
their use in predicting suicide.
The use of these scales, or an over-reliance on the identification of risk factors in clinical practice, may provide false reassurance and are, therefore, potentially dangerous. Comprehensive psychosocial assessments of the risks and needs that are specific to the individual should be central to the management of people who have self-harmed.
Language: en |