Show simple item record

dc.contributor.authorQuinlivan, L
dc.contributor.authorCooper, J
dc.contributor.authorMeehan, D
dc.contributor.authorLongson, D
dc.contributor.authorPotokar, J
dc.contributor.authorHulme, T
dc.contributor.authorMarsden, J
dc.contributor.authorBrand, F
dc.contributor.authorLange, K
dc.contributor.authorRiseborough, E
dc.contributor.authorPage, L
dc.contributor.authorMetcalfe, C
dc.contributor.authorDavies, L
dc.contributor.authorO'Connor, R
dc.contributor.authorHawton, K
dc.contributor.authorGunnell, D
dc.contributor.authorKapur, N
dc.date.accessioned2018-03-05T14:59:56Z
dc.date.issued2017-06
dc.identifier.citationBritish Journal of Psychiatry, 2017, 210 (6), pp. 429 - 436
dc.identifier.issn0007-1250
dc.identifier.urihttps://repository.icr.ac.uk/handle/internal/1547
dc.identifier.eissn1472-1465
dc.identifier.doi10.1192/bjp.bp.116.189993
dc.description.abstractBackground Scales are widely used in psychiatric assessments following self-harm. Robust evidence for their diagnostic use 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 Impulsiveness Scale); and patient and clinician estimates of risk in identifying patients who repeat self-harm within 6 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. The area under the curve (AUC) was used to determine optimal cut-offs and compare global accuracy. Results In total, 483 episodes of self-harm were included in the study. The episode-based 6-month repetition rate was 30% ( n = 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 ( P < 0.001). Conclusions 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.
dc.format.extent429 - 436
dc.languageeng
dc.language.isoeng
dc.publisherRoyal College of Psychiatrists
dc.titlePredictive accuracy of risk scales following self-harm: Multicentre, prospective cohort study
dc.typeJournal Article
rioxxterms.versionofrecord10.1192/bjp.bp.116.189993
rioxxterms.licenseref.startdate2017-06
rioxxterms.typeJournal Article/Review
dc.relation.isPartOfBritish Journal of Psychiatry
pubs.issue6
pubs.notesNot known
pubs.organisational-group/ICR
pubs.organisational-group/ICR/Primary Group
pubs.organisational-group/ICR/Primary Group/Royal Marsden Clinical Units
pubs.organisational-group/ICR
pubs.organisational-group/ICR/Primary Group
pubs.organisational-group/ICR/Primary Group/Royal Marsden Clinical Units
pubs.publication-statusPublished
pubs.volume210
pubs.embargo.termsNot known
dc.contributor.icrauthorMarsden,en


Files in this item

Thumbnail

This item appears in the following collection(s)

Show simple item record