ArticleBMJ mental health2024
Risk of repeat self-harm among individuals presenting to healthcare services: development and validation of a clinical risk assessment model (OxSET).
Article in BMJ mental health, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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Who cites it
6 citing papers in PubMed.
- External validation, recalibration and updating of the OxSATS risk model for suicide after self-harm in England.BMJ mental health · 2026Article
- Self-harm in individuals with substance use disorders: Predictive factors and risk model.Addiction (Abingdon, England) · 2026Article
- Clinician perspectives on the utility and acceptability of OxSATS: a qualitative study of a novel structured suicide risk assessment tool.BMJ mental health · 2026Article
- Clinical guidelines on self-harm and suicide prevention: taking uncertainty into account in the evidence base.BMJ mental health · 2026Article
- Completeness, consistency, and duplicity of self-mutilation reports by adolescents in the Notifiable Diseases Information System: evaluation study, Santa Catarina, 2014-2023.Epidemiologia e servicos de saude : revista do Sistema Unico de Saude do Brasil · 2026Article
- Bridging assessment and treatment for repeat suicidality in prisons: development and validation of a risk model.BMJ mental health · 2025Article
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10 authors.
Funding
Abstract
backgroundA self-harm episode is a major risk factor for repeat self-harm. Existing tools to assess and predict repeat self-harm have major methodological limitations, and few are externally validated.
objectiveTo develop and validate a risk assessment model of repeat self-harm up to 6 months after an episode of non-fatal self-harm that resulted in an emergency visit to hospital or specialised care.
methodsUsing Swedish national registers, we identified 53 172 people aged≥10 years who self-harmed during 2008-2012. We allocated 37 523 individuals to development (2820 or 7.5% repeat self-harm incidents within 6 months) and 15 649 to geographic validation (1373 repeat episodes) samples, based on region of residence. In a temporal validation of people who self-harmed during 2018-2019, we identified 25 036 individuals (2886 repeat episodes). We fitted a multivariable accelerated failure time model to predict risk of repeat self-harm.
findingsIn the external validations (n=40 685), rates of repeat self-harm were 8.8%-11.5% over 6 months. The final model retained 17 factors. Calibration and discrimination were similar in both validation samples, with observed-to-expected ratio=1.15 (95% CI=1.09 to 1.21) and c-statistic=0.72 (95% CI=0.70 to 0.73) in the geographical validation. At 6 months and a 10% risk cut-off, sensitivity was 51.5% (95% CI=48.8% to 54.2%) and specificity was 80.7% (95% CI=80.1% to 81.4%) in geographic validation; corresponding values were 56.9% (95% CI=55.1% to 58.7%) and 76.0% (95% CI=75.5% to 76.6%) in temporal validation. Discrimination was slightly worse at the 1-month prediction horizon (c-statistics of 0.66-0.68).
conclusionsUsing mostly routinely collected data, simple risk assessment models and tools can provide acceptable levels of accuracy for repeat of self-harm. CLINICAL IMPLICATIONS: This risk model (OXford SElf-harm repeat tool) may assist clinical decision-making.
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