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dc.contributor.authorQuinlivan, Len_US
dc.contributor.authorCooper, Jen_US
dc.contributor.authorMeehan, Den_US
dc.contributor.authorLongson, Den_US
dc.contributor.authorPotokar, Jen_US
dc.contributor.authorHulme, Ten_US
dc.contributor.authorMarsden, Jen_US
dc.contributor.authorBrand, Fen_US
dc.contributor.authorLange, Ken_US
dc.contributor.authorRiseborough, Een_US
dc.contributor.authorPage, Len_US
dc.contributor.authorMetcalfe, Cen_US
dc.contributor.authorDavies, Len_US
dc.contributor.authorO'Connor, Ren_US
dc.contributor.authorHawton, Ken_US
dc.contributor.authorGunnell, Den_US
dc.contributor.authorKapur, Nen_US
dc.date.accessioned2018-03-05T14:59:56Z
dc.date.issued2017-06en_US
dc.identifier.citationBritish Journal of Psychiatry, 2017, 210 (6), pp. 429 - 436en_US
dc.identifier.issn0007-1250en_US
dc.identifier.urihttps://repository.icr.ac.uk/handle/internal/1547
dc.identifier.eissn1472-1465en_US
dc.identifier.doi10.1192/bjp.bp.116.189993en_US
dc.description.abstract<jats:sec><jats:title>Background</jats:title><jats:p>Scales are widely used in psychiatric assessments following self-harm. Robust evidence for their diagnostic use is lacking.</jats:p></jats:sec><jats:sec><jats:title>Aims</jats:title><jats:p>To evaluate the performance of risk scales (Manchester Self-Harm Rule, ReACT Self-Harm Rule, SAD PERSONS scale, Modified SAD PERSONS scale, Barratt Impulsiveness Scale); and patient and clinician estimates of risk in identifying patients who repeat self-harm within 6 months.</jats:p></jats:sec><jats:sec><jats:title>Method</jats:title><jats:p>A multisite prospective cohort study was conducted of adults aged 18 years and over referred to liaison psychiatry services following self-harm. Scale <jats:italic>a priori</jats:italic> cut-offs were evaluated using diagnostic accuracy statistics. The area under the curve (AUC) was used to determine optimal cut-offs and compare global accuracy.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>In total, 483 episodes of self-harm were included in the study. The episode-based 6-month repetition rate was 30% (<jats:italic>n</jats:italic> = 145). 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. The AUC 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 global scale. The remaining scales performed significantly worse than clinician and patient estimates of risk (<jats:italic>P</jats:italic> &lt; 0.001).</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>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.</jats:p></jats:sec>en_US
dc.format.extent429 - 436en_US
dc.languageenen_US
dc.language.isoenen_US
dc.publisherRoyal College of Psychiatristsen_US
dc.titlePredictive accuracy of risk scales following self-harm: Multicentre, prospective cohort studyen_US
dc.typeJournal Article
rioxxterms.versionofrecord10.1192/bjp.bp.116.189993en_US
rioxxterms.licenseref.startdate2017-06en_US
rioxxterms.typeJournal Article/Reviewen_US
dc.relation.isPartOfBritish Journal of Psychiatryen_US
pubs.issue6en_US
pubs.notesNot knownen_US
pubs.organisational-group/ICR
pubs.organisational-group/ICR/Primary Group
pubs.organisational-group/ICR/Primary Group/Royal Marsden Clinical Units
pubs.publication-statusPublisheden_US
pubs.volume210en_US
pubs.embargo.termsNot knownen_US
dc.contributor.icrauthorMarsden,en_US


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