SynthesisBMJ open2016
Which are the most useful scales for predicting repeat self-harm? A systematic review evaluating risk scales using measures of diagnostic accuracy.
Synthesis in BMJ open, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT07120477 (Esketamine Versus Crisis Response Planning Versus Enhanced Treatment as Usual for Suicide Prevention), which is not on this map. Cited by 32 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Esketamine Versus Crisis Response Planning Versus Enhanced Treatment as Usual for Suicide Prevention: A Pragmatic Randomized Trial in a Brazilian Municipality (SAVE)
Who cites it
32 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Psychosocial interventions for self-harm and suicide prevention in liaison psychiatry: an overview of systematic reviews.BMC psychiatry · 2025Pooled it
- Predicting future self-harm or suicide in adolescents: a systematic review of risk assessment scales/tools.BMJ open · 2019Pooled it
- Increasing intentions to use mental health services among university students. Results of a pilot randomized controlled trial within the World Health Organization's World Mental Health International College Student Initiative.International journal of methods in psychiatric research · 2019Trial
- EUDOR-A multi-centre research program: A naturalistic, European Multi-centre Clinical study of EDOR Test in adult patients with primary depression.BMC psychiatry · 2017Trial
- Suicide in People With Co-occurring Substance Use and Mental Health Conditions: An Integrative Literature Review to Inform Risk Formulation in Mental Health Nursing.International journal of mental health nursing · 2026Review
- Metabolic syndrome increases the risk of suicide attempt: evidence from a population-based cohort and genomic analysis.Translational psychiatry · 2025Article
- Risk of repeat self-harm among individuals presenting to healthcare services: development and validation of a clinical risk assessment model (OxSET).BMJ mental health · 2024Article
- Impact of Implementation Facilitation on the REACH VET Clinical Program for Veterans at Risk for Suicide.Psychiatric services (Washington, D.C.) · 2024Article
- Development and evaluation of a predictive algorithm and telehealth intervention to reduce suicidal behavior among university students.Psychological medicine · 2024Article
- Implementing Machine Learning Models for Suicide Risk Prediction in Clinical Practice: Focus Group Study With Hospital Providers.JMIR formative research · 2022Article
- Hospital-Based Suicides: Challenging Existing Myths.The Psychiatric quarterly · 2022Review
- Evaluating the Risk of Suicide and Violence in Severe Mental Illness: A Feasibility Study of Two Risk Assessment Tools (OxMIS and OxMIV) in General Psychiatric Settings.Frontiers in psychiatry · 2022Article
- An Ecological Model for High-Risk Professional Decision-Making in Mental Health: International Perspectives.International journal of environmental research and public health · 2021Article
- Investigating the relationship between childhood sexual abuse, self-harm repetition and suicidal intent: mixed-methods study.BJPsych open · 2021Article
- Development and validation of the suicidal behaviours questionnaire - autism spectrum conditions in a community sample of autistic, possibly autistic and non-autistic adults.Molecular autism · 2021Article
- The Totalising Nature of Secure and Forensic Mental Health Services in England and Wales.Frontiers in psychiatry · 2021Article
- Accuracy of individual and combined risk-scale items in the prediction of repetition of self-harm: multicentre prospective cohort study.BJPsych open · 2020Article
- Measurement Properties of the Suicidal Behaviour Questionnaire-Revised in Autistic Adults.Journal of autism and developmental disorders · 2020Article
- An investigation of clinical decisionmaking: identifying important factors in treatment planning for suicidal patients in the emergency department.Journal of the American College of Emergency Physicians open · 2020Article
- Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors.
Funding
Abstract
objectivesThe aims of this review were to calculate the diagnostic accuracy statistics of risk scales following self-harm and consider which might be the most useful scales in clinical practice.
designSystematic review.
methodsWe based our search terms on those used in the systematic reviews carried out for the National Institute for Health and Care Excellence self-harm guidelines (2012) and evidence update (2013), and updated the searches through to February 2015 (CINAHL, EMBASE, MEDLINE, and PsychINFO). Methodological quality was assessed and three reviewers extracted data independently. We limited our analysis to cohort studies in adults using the outcome of repeat self-harm or attempted suicide. We calculated diagnostic accuracy statistics including measures of global accuracy. Statistical pooling was not possible due to heterogeneity.
resultsThe eight papers included in the final analysis varied widely according to methodological quality and the content of scales employed. Overall, sensitivity of scales ranged from 6% (95% CI 5% to 6%) to 97% (CI 95% 94% to 98%). The positive predictive value (PPV) ranged from 5% (95% CI 3% to 9%) to 84% (95% CI 80% to 87%). The diagnostic OR ranged from 1.01 (95% CI 0.434 to 2.5) to 16.3 (95%CI 12.5 to 21.4). Scales with high sensitivity tended to have low PPVs.
conclusionsIt is difficult to be certain which, if any, are the most useful scales for self-harm risk assessment. No scales perform sufficiently well so as to be recommended for routine clinical use. Further robust prospective studies are warranted to evaluate risk scales following an episode of self-harm. Diagnostic accuracy statistics should be considered in relation to the specific service needs, and scales should only be used as an adjunct to assessment.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.