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Cited by 501Suicide and Self-Harm StudiesHomicide, Infanticide, and Child AbuseOpioid Use Disorder Treatment

Predicting suicide following self-harm: systematic review of risk factors and risk scales

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Chan, Melissa K. Y., Bhatti, Henna, Meader, Nick, Stockton, Sarah, Evans, Jonathan, O'Connor, Rory C., Kapur, Nav, Kendall, Tim·2016·British Journal of Psychiatry
DOI 10.1192/bjp.bp.115.170050
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Abstract

Background: People with a history of self-harm are at a far greater risk of suicide than the general population. However, the relationship between self-harm and suicide is complex. Aims: To undertake the first systematic review and meta-analysis of prospective studies of risk factors and risk assessment scales to predict suicide following self-harm. Method: We conducted a search for prospective cohort studies of populations who had self-harmed. For the review of risk scales we also included studies examining the risk of suicide in people under specialist mental healthcare, in order to broaden the scope of the review and increase the number of studies considered. Differences in predictive accuracy between populations were examined where applicable. Results: Twelve studies on risk factors and 7 studies on risk scales were included. Four risk factors emerged from the metaanalysis, with robust effect sizes that showed little change when adjusted for important potential confounders. These included: previous episodes of self-harm (hazard ratio (HR) = 1.68, 95% CI 1.38–2.05, K = 4), suicidal intent (HR = 2.7, 95% CI 1.91–3.81, K = 3), physical health problems (HR = 1.99, 95% CI 1.16–3.43, K = 3) and male gender (HR = 2.05, 95% CI 1.70–2.46, K = 5). The included studies evaluated only three risk scales (Beck Hopelessness Scale (BHS), Suicide Intent Scale (SIS) and Scale for Suicide Ideation). Where meta-analyses were possible (BHS, SIS), the analysis was based on sparse data and a high heterogeneity was observed. The positive predictive values ranged from 1.3 to 16.7%. Conclusions: The four risk factors that emerged, although of interest, are unlikely to be of much practical use because they are comparatively common in clinical populations. No scales have sufficient evidence to support their use. The use of these scales, or an over-reliance on the identification of risk factors in clinical practice, may provide false reassurance and is, therefore, potentially dangerous. Comprehensive psychosocial assessments of the risks and needs that are specific to the individual should be central to the management of people who have self-harmed.

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Crossref · 10.1192/bjp.bp.115.170050

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  • Lack of specificity in suicide risk models likely arises from a multitude of risk factors that pertain to many people with no history of STBs.

    “Such lack of specificity likely arises from a multitude of risk factors in these models (e.g., psychiatric symptoms, age, sex) that pertain to many people with no history of STBs (Chan et al., 2016; Franklin et al., 2017).”

    From Toward objective characterizations of suicide risk: A narrative review of laboratory-based cognitive and behavioral tasks (2023) · cites this paper as Chan et al., 2016

    The Clinical implications section (page not available) says that risk factors are common in clinical populations and therefore unlikely to predict later suicide reliably after self-harm. The Methodological issues section also reports many false positives. Neither passage establishes that these factors are common among people with no history of suicidal thoughts or behaviors, as the citing sentence claims. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • Other studies, including a systematic review, confirmed that there is no evidence to support the use of risk assessment instruments as predictors of suicidal behaviour among patients with a psychiatric disorder.

    “Other studies, including a systematic review, confirmed that there is no evidence to support the use of risk assessment instruments as predictors of suicidal behaviour among patients with a psychiatric disorder 208,209 .”

    From Suicide and suicide risk (2019) · cites this paper as [208]

    The Main findings and Clinical implications sections report poor predictive value for the reviewed risk scales and insufficient evidence to support their use alone in clinical practice. The review examined suicide deaths among people who had self-harmed or were under specialist mental health care; it does not establish the claim for suicidal behaviour broadly or specifically for patients diagnosed with a psychiatric disorder. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Suicide prediction models rely heavily-and often exclusively-on explicit self-report measures that have relatively poor predictive value.

    “Suicide prediction models rely heavily— and often exclusively—on explicit self-report measures that have relatively poor predictive value; for a systematic review of risk assessment scales and their predictive power, see (Chan et al., 2016).”

    From Toward objective characterizations of suicide risk: A narrative review of laboratory-based cognitive and behavioral tasks (2023) · cites this paper as Chan et al., 2016

  • 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 Chan et al., 2016

    The Clinical implications section says risk scales have poor predictive value, but it does not evaluate personalized risk feedback or its effect on treatment use. Searches for personalized risk feedback and treatment utilization found no passage addressing the attributed experimental result. (LLM, conf=0.76)

    Experimental — accuracy not yet measured

  • Risk models for suicide used in emergency departments to assess self-harm have poor balance between sensitivity and specificity and do not provide probability scores.

    “Risk models for suicide have been used in emergency departments to assess persons who have harmed themselves, but these models have a poor balance between sensitivity and specificity and do not provide probability scores.48”

    From Suicide (2020) · cites this paper as [48]

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Research works printed but not linked: 1

  1. [36]36. Johnsson FE, Öjehagen A, Träskman-Bendz I. A 5-year follow-up study of suicide attempts. Acta Psychiatrica Scandinavica. 1996;93(3):151-7.

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Authors
Chan, M. K. Y., Bhatti, H., Meader, N., Stockton, S., Evans, J., O'Connor, R. C., Kapur, N., & Kendall, T.
Affiliations
Centre for Addiction and Mental Health (CA)
Corresponding author
Chan, Melissa K. Y.
ORCID
Venue
British Journal of Psychiatry
Publisher
Royal College of Psychiatrists
Published
2016-10
Volume
209
Issue
4
Pages
277-283
ISSN
  • 0007-1250 (ISSN-L)
  • 1472-1465
DOI
10.1192/bjp.bp.115.170050
OpenAlex
W2340460378
Cited by
501
References
45
Citations by year
2026: 27 · 2025: 41 · 2024: 41 · 2023: 60 · 2022: 45 · 2021: 90 · 2020: 58 · 2019: 45 · 2018: 50 · 2017: 41 · 2016: 2 · 2013: 1
FWCI
6.81
Type
journal article
Language
en
Open access
Licence
www.cambridge.org/core/terms (unspecified, 458 d)
Locations
  • The British Journal of Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • Explore Bristol Research (publishedVersion)
  • ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (acceptedVersion)
  • White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (submittedVersion)
  • Research Explorer (The University of Manchester) (submittedVersion)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
  • Social Sciences › Sociology and Political Science › Homicide, Infanticide, and Child Abuse
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
Keywords
self-harm, suicide risk, suicide risk prediction, risk factors, suicidal intent, hopelessness, physical health problems, male gender, suicidal ideation, psychosocial assessment
MeSH terms
Risk Factors, Suicide, Risk Assessment

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