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Cited by 79Suicide and Self-Harm StudiesPsychiatric care and mental health servicesEmergency and Acute Care Studies

Scales for predicting risk following self-harm: an observational study in 32 hospitals in England

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Quinlivan, L, Cooper, J, Steeg, S, Davies, L, Hawton, K, Gunnell, D, Kapur, N·2014·BMJ Open
DOI 10.1136/bmjopen-2013-004732PMC PMC4025469
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Abstract

Objective: To investigate the extent to which risk scales were used for the assessment of self-harm by emergency department clinicians and mental health staff, and to examine the association between the use of a risk scale and measures of service quality and repeat self-harm within 6 months. Design: Observational study. Setting: A stratified random sample of 32 hospitals in England. Participants: 6442 individuals presenting with self-harm to 32 hospital services during a 3-month period between 2010 and 2011. Outcomes: 21-item measure of service quality, repeat self-harm within 6 months. Results: A variety of different risk assessment tools were in use. Unvalidated locally developed proformas were the most commonly used instruments (reported in n=22 (68.8%) mental health services). Risk assessment scales were used in one-third of services, with the SAD PERSONS being the single most commonly used scale. There were no differences in service quality score between hospitals which did and did not use scales as a component of risk assessment (median service quality score (IQR): 14.5 (12.8, 16.4) vs 14.5 (11.4, 16.0), U=121.0, p=0.90), but hospitals which used scales had a lower median rate of repeat self-harm within 6 months (median repeat rate (IQR): 18.5% vs 22.7%, p=0.008, IRR (95% CI) 1.18 (1.00 to 1.37). When adjusted for differences in casemix, this association was attenuated (IRR=1.13, 95% CI (0.98 to 1.3)). Conclusions: There is little consensus over the best instruments for risk assessment following self-harm. Further research to evaluate the impact of scales following an episode of self-harm is warranted using prospective designs. Until then, it is likely that the indiscriminant use of risk scales in clinical services will continue.

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  • Other experimental evaluations of personalized risk feedback to increase treatment for mental health problems have yielded weak results.

    “However, other experimental evaluations of the effects of personalized risk feedback to increase treatment for mental health problems have yielded weak results (Chan et al., 2016; King et al., 2015; Quinlivan et al., 2014; Quinlivan et al., 2016), although one study reported an effect on utilization in some subgroups (Batterham, Calear, Sunderland, Carragher, & Brewer, 2016).”

    From 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 (2019) · cites this paper as Quinlivan et al., 2014

    The Discussion (Strengths and limitations; page unavailable) explicitly calls this an observational study and says it cannot infer causation, contrary to describing it as an experimental evaluation. The Method (Outcomes; page unavailable) compares hospitals using risk scales with those not using them and measures service quality and repeat self-harm—not the effect of personalized risk feedback on mental-health treatment uptake. Its discussion of weak evidence concerns risk-assessment scales, not the claimed intervention. (LLM, conf=0.88)

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Research works printed but not linked: 26

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Authors
Quinlivan, L., Cooper, J., Steeg, S., Davies, L., Hawton, K., Gunnell, D., & Kapur, N.
Affiliations
  • University of Manchester (GB)
  • Warneford Hospital (GB)
  • University of Bristol (GB)
Corresponding author
Quinlivan, L
ORCID
Venue
BMJ Open
Publisher
BMJ
Published
2014-04
Volume
4
Issue
5
Pages
e004732
ISSN
2044-6055 (ISSN-L)
DOI
10.1136/bmjopen-2013-004732
PMC
PMC4025469
OpenAlex
W2107314415
Cited by
79
References
3
Citations by year
2026: 2 · 2025: 3 · 2024: 6 · 2023: 8 · 2022: 1 · 2021: 8 · 2020: 9 · 2019: 8 · 2018: 11 · 2017: 7 · 2016: 8 · 2015: 7 · 2014: 1
FWCI
9.07
Type
journal article
Language
en
Open access
Licence
cc-by-nc
Locations
  • BMJ Open (publishedVersion, cc-by-nc)
  • Europe PMC (PubMed Central) (publishedVersion, other-oa)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • Research Explorer (The University of Manchester) (publishedVersion, cc-by)
  • Research Explorer (The University of Manchester) (publishedVersion)
  • HighWire Press Open Archive (submittedVersion)
  • Bristol Research (University of Bristol) (submittedVersion)
  • Explore Bristol Research (submittedVersion)
Funders
  • National Institute for Health and Care Research (NF-SI-0508-10053, RP-PG-0606-1247, RP-PG-0610-10026, NF-SI-0512-10068)
  • Programme Grants for Applied Research (RP-PG-0610-10026)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
  • Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
  • Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
Keywords
self-harm, risk assessment scale, repeat self-harm, service quality, emergency department, mental health services, risk assessment tools, case mix
MeSH terms
Adult, England, Female, Hospitals, Humans, Male, Surveys and Questionnaires, Time Factors, Self-Injurious Behavior, Risk Assessment

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