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Cole R, Kynn M, Carberry A, Jones R, Parekh S, Whitehead E, Taylor J, Merollini K. Examining service utilisation and impact among consumers of a national mental health stepped care programme in Australia: a protocol using linked administrative data. BMJ Open 2023; 13:e072404. [PMID: 37419645 PMCID: PMC10335474 DOI: 10.1136/bmjopen-2023-072404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 06/16/2023] [Indexed: 07/09/2023] Open
Abstract
INTRODUCTION Mental well-being is a global public health priority with increasing mental health conditions having substantial burden on individuals, health systems and society. 'Stepped care', where services are provided at an intensity to meet the changing needs of the consumer, is the chosen approach to mental health service delivery in primary healthcare in Australia for its efficiencies and patient outcomes; yet limited evidence exists on how the programme is being rolled out and its impact in practice. This protocol outlines a data linkage project to characterise and quantify healthcare service utilisation and impacts among a cohort of consumers of a national mental health stepped care programme in one region of Australia. METHODS AND ANALYSIS Data linkage will be used to establish a retrospective cohort of consumers of mental health stepped care services between 1 July 2020 and 31 December 2021 in one primary healthcare region in Australia (n=approx. 12 710). These data will be linked with records from other healthcare service data sets (eg, hospitalisations, emergency department presentations, community-based state government-delivered mental healthcare, hospital costs). Four areas for analysis will include: (1) characterising the nature of mental health stepped care service use; (2) describing the cohort's sociodemographic and health characteristics; (3) quantifying broader service utilisation and associated economic costs; and (4) assessing the impact of mental health stepped care service utilisation on health and service outcomes. ETHICS AND DISSEMINATION Approval from the Darling Downs Health Human Research Ethics Committee (HREA/2020/QTDD/65518) has been granted. All data will be non-identifiable, and research findings will be disseminated through peer-reviewed journals, conference presentations and industry meetings.
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Affiliation(s)
- Rachel Cole
- School of Health, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
- Sunshine Coast Health Network, Maroochydore, Queensland, Australia
| | - Mary Kynn
- School of Electrical Engineering, Computing and Mathematical Sciences, Curtin University, Perth, Western Australia, Australia
| | - Angela Carberry
- Sunshine Coast Health Network, Maroochydore, Queensland, Australia
| | - Rhian Jones
- Sunshine Coast Health Network, Maroochydore, Queensland, Australia
| | | | - Emma Whitehead
- Sunshine Coast Health Network, Maroochydore, Queensland, Australia
| | - Jane Taylor
- School of Health, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
| | - Katharina Merollini
- School of Health, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
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Alfa-Wali M, Ghosh P, Koutsouris S, Aylwin C, Ward P, Elliott M, Reid S, Batrick N. Deliberate self-harm and trauma - A descriptive analysis from a London major trauma centre. Injury 2023; 54:232-237. [PMID: 36503837 DOI: 10.1016/j.injury.2022.11.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 11/13/2022] [Accepted: 11/25/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The objective of this study is to present a retrospective analysis of patients presenting to a Major Trauma Centre (MTC) following deliberate self-harm (DSH) and identifying the precipitants of DSH and psychiatric morbidity that will serve to inform the provision of care for these patients. PATIENTS AND METHODS This was a retrospective observational study from a London Major Trauma Centre that identified all injured patients that presented with deliberate self-harm. Data was analysed from our established trauma database. The data was analysed using descriptive statistics. RESULTS This included 347 patients of whom 253 were male and 94 were female. The median age was 36 (range 14-93) years. Penetrating injuries (shooting and stabbing) occurred in 187 (54%) patients and blunt injuries in 160 (46%) patients. Self-stabbing (52%) was the most common cause for presentation followed by jumping from a height (26%). The median Injury Severity Score (ISS) was 4 (range 1-9). The median LOS was 3 days (range 0-109), with a mean stay of 8 days. Over half of the patients (n = 189) had previous contact with mental health services. Social and mental health were the main triggers for DSH. CONCLUSIONS Societal and economic factors as well as a mental disorder are associated with trauma related DSH. These complex group of patients presenting to MTCs have not only acute surgical needs but social and psychological as well. Raising awareness of patients' mental health needs across the whole pathway for the major trauma patient is crucial to ensure that appropriate risk assessments are undertaken at every stage. It is also essential to provide psychological support to the multi-disciplinary team for their wellbeing.
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Affiliation(s)
- Maryam Alfa-Wali
- St Mary's Hospital, Major Trauma Centre, Praed Street, Paddington, London W2 1NY, UK.
| | - Pia Ghosh
- Camden and Islington Mental Health Trust, St Pancras Way, London NW1 0PE, UK
| | - Stefanos Koutsouris
- St Mary's Hospital, Major Trauma Centre, Praed Street, Paddington, London W2 1NY, UK
| | - Christopher Aylwin
- St Mary's Hospital, Major Trauma Centre, Praed Street, Paddington, London W2 1NY, UK
| | - Patricia Ward
- St Mary's Hospital, Major Trauma Centre, Praed Street, Paddington, London W2 1NY, UK
| | - Michele Elliott
- Barking, Havering and Redbridge University Hospitals NHS Trust, 4 Lyon Road, Romford RM1 2BA, UK
| | - Steve Reid
- St Mary's Hospital, Major Trauma Centre, Praed Street, Paddington, London W2 1NY, UK
| | - Nicola Batrick
- St Mary's Hospital, Major Trauma Centre, Praed Street, Paddington, London W2 1NY, UK
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Goldstein TR, Merranko J, Hafeman D, Gill MK, Liao F, Sewall C, Hower H, Weinstock L, Yen S, Goldstein B, Keller M, Strober M, Ryan N, Birmaher B. A risk calculator to predict suicide attempts among individuals with early-onset bipolar disorder. Bipolar Disord 2022; 24:749-757. [PMID: 36002150 DOI: 10.1111/bdi.13250] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To build a one-year risk calculator (RC) to predict individualized risk for suicide attempt in early-onset bipolar disorder. METHODS Youth numbering 394 with bipolar disorder who completed ≥2 follow-up assessments (median follow-up length = 13.1 years) in the longitudinal Course and Outcome of Bipolar Youth (COBY) study were included. Suicide attempt over follow-up was assessed via the A-LIFE Self-Injurious/Suicidal Behavior scale. Predictors from the literature on suicidal behavior in bipolar disorder that are readily assessed in clinical practice were selected and trichotomized as appropriate (presence past 6 months/lifetime history only/no lifetime history). The RC was trained via boosted multinomial classification trees; predictions were calibrated via Platt scaling. Half of the sample was used to train, and the other half to independently test the RC. RESULTS There were 249 suicide attempts among 106 individuals. Ten predictors accounted for >90% of the cross-validated relative influence in the model (AUC = 0.82; in order of relative influence): (1) age of mood disorder onset; (2) non-suicidal self-injurious behavior (trichotomized); (3) current age; (4) psychosis (trichotomized); (5) socioeconomic status; (6) most severe depressive symptoms in past 6 months (trichotomized none/subthreshold/threshold); (7) history of suicide attempt (trichotomized); (8) family history of suicidal behavior; (9) substance use disorder (trichotomized); (10) lifetime history of physical/sexual abuse. For all trichotomized variables, presence in the past 6 months reliably predicted higher risk than lifetime history. CONCLUSIONS This RC holds promise as a clinical and research tool for prospective identification of individualized high-risk periods for suicide attempt in early-onset bipolar disorder.
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Affiliation(s)
- Tina R Goldstein
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - John Merranko
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Danella Hafeman
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Mary Kay Gill
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Fangzi Liao
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Craig Sewall
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Heather Hower
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Lauren Weinstock
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Shirley Yen
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Massachusetts Mental Health Center and the Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | | | - Martin Keller
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Michael Strober
- Department of Psychiatry, University of California, Los Angeles, California, USA
| | - Neal Ryan
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Boris Birmaher
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Lawrence RE, Krumheuer A, Loh R, Stanley B, Simpson SA. Persons Who Engage in Self-Harm While in the Emergency Department: A Case-Control Analysis. J Nerv Ment Dis 2022; 210:736-740. [PMID: 36179373 PMCID: PMC9525888 DOI: 10.1097/nmd.0000000000001528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Some patients engage in self-harm behaviors while in the emergency department. Risk factors for self-harm have been described for inpatient and outpatient/community settings, but not among emergency department patients. Authors conducted case-control, retrospective reviews of medical records and incident reports for emergency department patients in two academic medical centers. Variables were analyzed using conditional logistic regression. There were 113 individuals who engaged in self-harm while in the emergency department and 226 individuals who did not. Four variables were significant in the final model: a history of nonsuicidal self-harm (odds ratio [OR], 4.28; 95% confidence interval [CI], 1.95-9.41), opioid use in the prior 2 weeks (OR, 2.89; CI, 1.19-7.02), current manic episode (OR, 3.59; CI, 1.33-9.70), and a history of seizures (OR, 4.19; CI, 1.16-15.14). Risk of self-harm while in the emergency department may be mitigated with interventions that support adaptive coping skills, promptly address pain and withdrawal symptoms, and treat mania.
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Affiliation(s)
- Ryan E Lawrence
- Department of Psychiatry, New York State Psychiatric Institute, New York, New York
| | - Aaron Krumheuer
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan
| | - Ryan Loh
- Department of Behavioral Health Services, Denver Health and Hospital Authority, Denver, Colorado
| | - Barbara Stanley
- Department of Psychiatry, New York State Psychiatric Institute, New York, New York
| | - Scott A Simpson
- Department of Behavioral Health Services, Denver Health and Hospital Authority, Denver, Colorado
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Suicidality in clinically stable bipolar disorder and schizophrenia patients during the COVID-19 pandemic. Transl Psychiatry 2022; 12:303. [PMID: 35906234 PMCID: PMC9335454 DOI: 10.1038/s41398-022-02045-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 06/26/2022] [Accepted: 06/29/2022] [Indexed: 11/14/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has a disproportionate impact on vulnerable subpopulations, including those with severe mental illness (SMI). This study examined the one-year prevalence of suicidal ideation (SI), suicide plans (SP), and suicide attempts (SA) in bipolar disorder (BD) and schizophrenia (SCZ) patients during the pandemic. Prevalence rates were compared between the two disorders and associated factors were examined. A survey was conducted in six tertiary psychiatric hospitals and psychiatric units. People with a diagnosis of BD or SCZ were invited to participate. SI, SP, and SA (suicidality for short) were assessed and associated factors were examined using binary logistical regression. The 1-year prevalence of SI, SP and SA in BD patients were 58.3%, (95% CI: 54.1-62.6%), 38.4% (95% CI: 34.3-42.6%) and 38.6% (95% CI: 34.5-42.8%), respectively, which were higher than the corresponding figures in SCZ patients (SI: 33.2%, 95% CI: 28.6-37.8%; SP: 16.8%, 95% CI: 13.2-20.5%; SA: 19.4%, 95% CI: 15.5-23.3%). Patients with younger age, experience of cyberbullying, a history of SA among family or friends, a higher fatigue and physical pain score, inpatient status, and severe depressive symptoms were more likely to have suicidality. The COVID-19 pandemic was associated with increased risk of suicidality, particularly in BD patients. It is of importance to regularly screen suicidality in BD and SCZ patients during the pandemic even if they are clinically stable.
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Balbuena LD, Baetz M, Sexton JA, Harder D, Feng CX, Boctor K, LaPointe C, Letwiniuk E, Shamloo A, Ishwaran H, John A, Brantsæter AL. Identifying long-term and imminent suicide predictors in a general population and a clinical sample with machine learning. BMC Psychiatry 2022; 22:120. [PMID: 35168594 PMCID: PMC8848909 DOI: 10.1186/s12888-022-03702-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 01/12/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Machine learning (ML) is increasingly used to predict suicide deaths but their value for suicide prevention has not been established. Our first objective was to identify risk and protective factors in a general population. Our second objective was to identify factors indicating imminent suicide risk. METHODS We used survival and ML models to identify lifetime predictors using the Cohort of Norway (n=173,275) and hospital diagnoses in a Saskatoon clinical sample (n=12,614). The mean follow-up times were 17 years and 3 years for the Cohort of Norway and Saskatoon respectively. People in the clinical sample had a longitudinal record of hospital visits grouped in six-month intervals. We developed models in a training set and these models predicted survival probabilities in held-out test data. RESULTS In the general population, we found that a higher proportion of low-income residents in a county, mood symptoms, and daily smoking increased the risk of dying from suicide in both genders. In the clinical sample, the only predictors identified were male gender and older age. CONCLUSION Suicide prevention probably requires individual actions with governmental incentives. The prediction of imminent suicide remains highly challenging, but machine learning can identify early prevention targets.
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Affiliation(s)
- Lloyd D Balbuena
- Department of Psychiatry, University of Saskatchewan, Saskatoon, Canada.
| | - Marilyn Baetz
- College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | | | - Douglas Harder
- Mental Health & Addictions Services, Saskatchewan Health Authority, Saskatoon, Canada
| | - Cindy Xin Feng
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Canada
| | - Kerstina Boctor
- Department of Psychiatry, University of Saskatchewan, Saskatoon, Canada
| | - Candace LaPointe
- Mental Health & Addictions Services, Saskatchewan Health Authority, Saskatoon, Canada
| | - Elizabeth Letwiniuk
- Mental Health & Addictions Services, Saskatchewan Health Authority, Saskatoon, Canada
| | - Arash Shamloo
- Department of Psychiatry, University of Saskatchewan, Saskatoon, Canada
| | | | - Ann John
- Swansea University Medical School, Swansea University, Swansea, United Kingdom
| | - Anne Lise Brantsæter
- Department of Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
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Ceniti AK, Heinecke N, McInerney SJ. Examining suicide-related presentations to the emergency department. Gen Hosp Psychiatry 2020; 63:152-157. [PMID: 30268506 DOI: 10.1016/j.genhosppsych.2018.09.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 07/17/2018] [Accepted: 09/15/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Although the Emergency Department (ED) is a frequent point of contact for individuals with suicide-related behaviour (SRB) or ideation, there is limited literature specifically examining presentations to the ED for SRB. This review examines the international literature published in North America, the United Kingdom and Australia relating to presentations to the ED for SRB, with focus on high-risk groups, screening tools used in the ED, and difficulties in classifying ED presentations of SRB. METHOD The database PubMed was searched using relevant terms, and national health care administrative data were reviewed. RESULTS Psychiatric history, substance use, and lower socioeconomic status were all found to be associated with higher rates of ED presentations for SRB. Limited research exists around ED presentations of SRB by particular high-risk groups, including lesbian, gay, bisexual, and transgender populations and Indigenous peoples. Individuals who present to EDs for SRB are often chronic users of EDs and have a high rate of repeat self-harm and death by suicide. CONCLUSION These findings suggest that EDs could serve as a focal point for suicide treatment interventions. Deepening our understanding of ED presentations for SRB could inform further development and implementation of interventions to reduce death by suicide.
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Affiliation(s)
- Amanda K Ceniti
- Arthur Sommer Rotenberg Suicide & Depression Studies Program, St. Michael's Hospital, Toronto, Ontario, Canada; Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Nicole Heinecke
- Arthur Sommer Rotenberg Suicide & Depression Studies Program, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Shane J McInerney
- Arthur Sommer Rotenberg Suicide & Depression Studies Program, St. Michael's Hospital, Toronto, Ontario, Canada; Krembil Research Institute, Toronto Western Hospital, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada; Department of Psychiatry, St. Michael's Hospital, University Health Network & University of Toronto, Toronto, Ontario, Canada.
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8
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Harris IM, Beese S, Moore D. Predicting future self-harm or suicide in adolescents: a systematic review of risk assessment scales/tools. BMJ Open 2019; 9:e029311. [PMID: 31494608 PMCID: PMC6731844 DOI: 10.1136/bmjopen-2019-029311] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE This systematic review aimed to evaluate the ability of risk tools to predict the future episodes of suicide/self-harm in adolescents. DESIGN Systematic review. DATA SOURCES MEDLINE, EMBASE, CINAHL and PsycINFO were searched from inception to 3 March 2018. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Cohort studies, case-control studies and randomised controlled trials of adolescents aged 10-25 who had undergone risk assessment in a clinical setting following an episode of self-harm were included. DATA EXTRACTION AND SYNTHESIS Two independent reviewers extracted data and assessed risk of bias. Data were grouped by tool and narrative synthesis undertaken, with studies appraised using a checklist combining the QUIPS (Quality In Prognosis Studies) and QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies) tools. RESULTS Of the 17 137 articles initially identified, 11 studies evaluating 10 separate tools were included. The studies varied in setting, population and outcome measure. The majority of the studies were rated as having an unclear risk of bias, and meta-analysis was not possible due to high variability between studies.The ability of the tools to correctly identify those adolescents going on to make a self-harm/suicide attempt ranged from 27% (95% CI 10.7% to 50.2%) to 95.8% (95% CI 78.9% to 99.9%). A variety of metrics were provided for 1-10 points increases in various tools, for example, odds and HRs. CONCLUSIONS This systematic review is the first to explore the use of assessment tools in adolescents. The predictive ability of these tools varies greatly. No single tool is suitable for predicting a higher risk of suicide or self-harm in adolescent populations. PROSPERO REGISTRATION NUMBER CRD42017058686.
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Affiliation(s)
| | - Sophie Beese
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - David Moore
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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Randall JR, Sareen J, Chateau D, Bolton JM. Predicting Future Suicide: Clinician Opinion versus a Standardized Assessment Tool. Suicide Life Threat Behav 2019; 49:941-951. [PMID: 29920749 DOI: 10.1111/sltb.12481] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 04/16/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To compare the effectiveness of clinician prediction of risk to a standardized assessment of presentation status. METHODS All adult psychiatry emergency department consults in the two main hospitals in Winnipeg, Canada, were assessed using a standardized form (n = 5,376). This form includes two risk scales for a gestalt physician assessment of risk (Suicide Likelihood scale, suicide Attempt Likelihood scale) and the Columbia Classification Algorithm of Suicide Assessment (C-CASA). Regression determined whether assessments predicted future suicide attempts and deaths. The area under the curve (AUC) determined the prediction accuracy of these methods. RESULTS Although the regression results were significant, the AUCs were either moderate or poor. Clinician assessment was not effective at predicting deaths (AUC = .546, .36-.73), but moderately accurate at predicting future attempts (AUC = .728, .66-.79). C-CASA assessment was moderately accurate at predicting both attempts and deaths (AUC = .666 and .678). CONCLUSIONS Clinician assessment does not significantly outperform a simple assessment of the occurrence of suicidal thoughts and behaviors during presentation to the emergency department. Behavior-based standardized assessments should be further researched in this field. Assessment of suicidality at presentation using C-CASA or similar assessment should be standard for psychiatric patients assessed in the emergency department.
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Affiliation(s)
- Jason R Randall
- Department of Community Health Sciences, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Manitoba Centre for Health Policy, Department of Community Health Sciences, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Injury Prevention Centre, School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Jitender Sareen
- Department of Community Health Sciences, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Department of Psychiatry, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Dan Chateau
- Department of Community Health Sciences, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Manitoba Centre for Health Policy, Department of Community Health Sciences, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Injury Prevention Centre, School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - James M Bolton
- Department of Community Health Sciences, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Manitoba Centre for Health Policy, Department of Community Health Sciences, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Department of Psychiatry, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
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10
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Harris IM, Beese S, Moore D. Predicting repeated self-harm or suicide in adolescents and young adults using risk assessment scales/tools: a systematic review protocol. Syst Rev 2019; 8:87. [PMID: 30947743 PMCID: PMC6449918 DOI: 10.1186/s13643-019-1007-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 03/25/2019] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Self-harm and suicide have been identified as serious public health problems in children, adolescents, and young people across the world. Suicide is a major cause of mortality in this population and is commonly preceded by self-harm. Both suicide and self-harm are difficult to predict, and several risk scales and tools are in use for this purpose. Currently, there is only a small amount of evidence available regarding their predictive ability in clinical practice, and no consensus as to which is the most suitable for particular populations or settings. The aim of this review is to evaluate the ability of risk scales to predict future episodes of suicide or self-harm in adolescents and young adults presenting to clinical services with attempted suicide or an episode of self-harm. METHODS A comprehensive search of electronic databases (MEDLINE, EMBASE, CINAHL, and PsycINFO) from inception will be conducted to identify studies that look at the ability of risk scales to predict suicide or future episodes of self-harm in adolescents and young adults presenting to clinical services with attempted suicide or an episode of self-harm. Two authors will independently carry out key methodological steps such as study screening and selection and data extraction. Quality assessment will be carried out using a checklist developed from the QUIPS and QUADAS-2 tools. Data will be grouped by tool and a narrative synthesis undertaken. For each tool, meta-analysis will be undertaken for ability to predict suicide or repeat self-harm where clinical and methodological homogeneity exists. DISCUSSION This systematic review will be the first to explore the use of assessment scales/tools in an adolescent population and will help to inform current practice regarding scales/tools with higher predictive ability. There is currently no evidence specifically for this population and a clear need with a high prevalence of self-harm and suicide in adolescents. Additionally, this review will help guide future research into suicide and self-harm prediction and prevention. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42017058686.
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Affiliation(s)
- Isobel Marion Harris
- Institute of Applied Health Research, Public Health Building, University of Birmingham, Birmingham, B15 2TT UK
| | - Sophie Beese
- Institute of Applied Health Research, Public Health Building, University of Birmingham, Birmingham, B15 2TT UK
| | - David Moore
- Institute of Applied Health Research, Public Health Building, University of Birmingham, Birmingham, B15 2TT UK
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11
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Randall JR, Roos LL, Lix LM, Katz LY, Bolton JM. Emergency department and inpatient coding for self-harm and suicide attempts: Validation using clinician assessment data. Int J Methods Psychiatr Res 2017; 26:e1559. [PMID: 28233360 PMCID: PMC6877200 DOI: 10.1002/mpr.1559] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 12/01/2016] [Accepted: 01/13/2017] [Indexed: 11/06/2022] Open
Abstract
Administrative data have been used to determine the occurrence of suicide attempts and deliberate self-harm, but research about the accuracy of these sources is limited. This study used a clinical sample (n = 5719) containing psychiatry consultations from the emergency departments and inpatient units of the two major tertiary hospitals in Winnipeg, Canada to validate the accuracy of inpatient hospital diagnosis codes at identifying presentations for self-harm and suicide attempts. The Columbia Classification Algorithm of Suicide Assessment (C-CASA) was used as the gold standard. International Classification of Diseases version 10 Canadian Enhancement codes for intentional self-harm, undetermined intent self-harm, and accidental poisoning were assessed. Measures of validity included Kappa (κ), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Sensitivity of hospitalized attempts was low using intentional intent codes (36.9%, 95% confidence interval [CI]: 32.4-41.4%) but improved using unknown intent and accidental poisoning codes (44.8%, 95% CI: 40.2-49.4%). Agreement for suicide attempts did not increase with the addition of unknown intent and accidental poisoning codes (κ = 0.465-0.481), but were better for any self-harm (κ = 0.395-0.478). Hospital diagnosis codes undercount attempts and self-harm admissions. Including more data sources might improve the detection of events.
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Affiliation(s)
- Jason R Randall
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,Manitoba Center for Health Policy, Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Leslie L Roos
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,Manitoba Center for Health Policy, Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Lisa M Lix
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Laurence Y Katz
- Manitoba Center for Health Policy, Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Psychiatry, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - James M Bolton
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,Manitoba Center for Health Policy, Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Psychiatry, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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12
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Katz C, Randall JR, Sareen J, Chateau D, Walld R, Leslie WD, Wang J, Bolton JM. Predicting suicide with the SAD PERSONS scale. Depress Anxiety 2017; 34:809-816. [PMID: 28471534 DOI: 10.1002/da.22632] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 03/09/2017] [Accepted: 03/14/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Suicide is a major public health issue, and a priority requirement is accurately identifying high-risk individuals. The SAD PERSONS suicide risk assessment scale is widely implemented in clinical settings despite limited supporting evidence. This article aims to determine the ability of the SAD PERSONS scale (SPS) to predict future suicide in the emergency department. METHODS Five thousand four hundred sixty-two consecutive adults were seen by psychiatry consultation teams in two tertiary emergency departments with linkage to population-based administrative data to determine suicide deaths within 6 months, 1, and 5 years. RESULTS Seventy-seven (1.4%) individuals died by suicide during the study period. When predicting suicide at 12 months, medium- and high-risk scores on SPS had a sensitivity of 49% and a specificity of 60%; the positive and negative predictive values were 0.9 and 99%, respectively. Half of the suicides at both 6- and 12-month intervals were classified as low risk by SPS at index visit. The area under the curve at 12 months for the Modified SPS was 0.59 (95% confidence interval [CI] range 0.51-0.67). High-risk scores (compared to low risk) were significantly associated with death by suicide over the 5-year study period using the SPS (hazard ratio 2.49; 95% CI 1.34-4.61) and modified version (hazard ratio 2.29; 95% CI 1.24-2.29). CONCLUSIONS Although widely used in educational and clinical settings, these findings do not support the use of the SPS and Modified SPS to predict suicide in adults seen by psychiatric services in the emergency department.
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Affiliation(s)
- Cara Katz
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jason R Randall
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jitender Sareen
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Dan Chateau
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada.,Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Randy Walld
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - William D Leslie
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - JianLi Wang
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - James M Bolton
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada.,Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
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13
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Quinlivan L, Cooper J, Meehan D, Longson D, Potokar J, Hulme T, Marsden J, Brand F, Lange K, Riseborough E, Page L, Metcalfe C, Davies L, O'Connor R, Hawton K, Gunnell D, Kapur N. Predictive accuracy of risk scales following self-harm: multicentre, prospective cohort study. Br J Psychiatry 2017; 210:429-436. [PMID: 28302702 PMCID: PMC5451643 DOI: 10.1192/bjp.bp.116.189993] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 10/05/2016] [Accepted: 11/13/2016] [Indexed: 11/23/2022]
Abstract
BackgroundScales are widely used in psychiatric assessments following self-harm. Robust evidence for their diagnostic use is lacking.AimsTo 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.MethodA 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.ResultsIn 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).ConclusionsRisk 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.
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Affiliation(s)
- Leah Quinlivan
- Leah Quinlivan, PhD, Jayne Cooper, PhD, Centre for Suicide Prevention, Manchester Academic Health Science Centre, University of Manchester, Manchester; Declan Meehan, RMN, Damien Longson, FRCPsych, Greater Manchester Mental Health and NHS Foundation Trust, Manchester; John Potokar, MRCPsych, Avon & Wiltshire Mental Health Foundation Trust, Bristol, University Hospitals Bristol, NHS Foundation Trust, Bristol and School of Social and Community Medicine, University of Bristol, Bristol; Tom Hulme, MSc, University Hospitals Bristol, NHS Foundation Trust, Bristol, Bristol; Jennifer Marsden, BA, Derbyshire Healthcare NHS Foundation Trust, Derby; Fiona Brand, RMN, Kezia Lange, MRCPsych, Oxford Health NHS Foundation Trust, Oxford; Elena Riseborough, RMN, Lisa Page, PhD, Sussex Partnership NHS Foundation Trust, Worthing; Chris Metcalfe, PhD, School of Social and Community Medicine, University of Bristol, Bristol; Linda Davies, Institute of Population Health, University of Manchester, Manchester; Rory O' Connor, PhD, Institute of Health and Wellbeing, University of Glasgow, Glasgow; Keith Hawton, DSc, Centre for Suicide Research, University Department of Psychiatry, Warneford Hospital, Oxford; David Gunnell, DSc, School of Social and Community Medicine, University of Bristol, Bristol; Nav Kapur, MBChB, MMedSci, MD, FRCPsych, Centre for Suicide Prevention, Manchester Academic Health Science Centre, University of Manchester, and Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
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14
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Carter G, Milner A, McGill K, Pirkis J, Kapur N, Spittal MJ. Predicting suicidal behaviours using clinical instruments: systematic review and meta-analysis of positive predictive values for risk scales. Br J Psychiatry 2017; 210:387-395. [PMID: 28302700 DOI: 10.1192/bjp.bp.116.182717] [Citation(s) in RCA: 208] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Revised: 10/16/2016] [Accepted: 11/16/2016] [Indexed: 01/17/2023]
Abstract
BackgroundPrediction of suicidal behaviour is an aspirational goal for clinicians and policy makers; with patients classified as 'high risk' to be preferentially allocated treatment. Clinical usefulness requires an adequate positive predictive value (PPV).AimsTo identify studies of predictive instruments and to calculate PPV estimates for suicidal behaviours.MethodA systematic review identified studies of predictive instruments. A series of meta-analyses produced pooled estimates of PPV for suicidal behaviours.ResultsFor all scales combined, the pooled PPVs were: suicide 5.5% (95% CI 3.9-7.9%), self-harm 26.3% (95% CI 21.8-31.3%) and self-harm plus suicide 35.9% (95% CI 25.8-47.4%). Subanalyses on self-harm found pooled PPVs of 16.1% (95% CI 11.3-22.3%) for high-quality studies, 32.5% (95% CI 26.1-39.6%) for hospital-treated self-harm and 26.8% (95% CI 19.5-35.6%) for psychiatric in-patients.ConclusionsNo 'high-risk' classification was clinically useful. Prevalence imposes a ceiling on PPV. Treatment should reduce exposure to modifiable risk factors and offer effective interventions for selected subpopulations and unselected clinical populations.
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Affiliation(s)
- Gregory Carter
- Gregory Carter, MBBS, Cert Child Psych, PhD, FRANZCP, Centre for Brain and Mental Health Research, University of Newcastle, New South Wales, Australia; Allison Milner, BJPsych (Hons), MEpi, PhD, Population Health Strategic Research Centre, Deakin University, Burwood, and Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia; Katie McGill, MPsych (Clin), DClinPsych, Centre for Brain and Mental Health Research, University of Newcastle, New South Wales, Australia; Jane Pirkis, MPsych, MAppEpid, PhD, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia; Nav Kapur, MBChB, MMedSci, MD, FRCPsych, Centre for Suicide Prevention, Manchester Academic Health Science Centre, University of Manchester, and Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK; Matthew J. Spittal, MBiostat, PhD, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Allison Milner
- Gregory Carter, MBBS, Cert Child Psych, PhD, FRANZCP, Centre for Brain and Mental Health Research, University of Newcastle, New South Wales, Australia; Allison Milner, BJPsych (Hons), MEpi, PhD, Population Health Strategic Research Centre, Deakin University, Burwood, and Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia; Katie McGill, MPsych (Clin), DClinPsych, Centre for Brain and Mental Health Research, University of Newcastle, New South Wales, Australia; Jane Pirkis, MPsych, MAppEpid, PhD, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia; Nav Kapur, MBChB, MMedSci, MD, FRCPsych, Centre for Suicide Prevention, Manchester Academic Health Science Centre, University of Manchester, and Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK; Matthew J. Spittal, MBiostat, PhD, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Katie McGill
- Gregory Carter, MBBS, Cert Child Psych, PhD, FRANZCP, Centre for Brain and Mental Health Research, University of Newcastle, New South Wales, Australia; Allison Milner, BJPsych (Hons), MEpi, PhD, Population Health Strategic Research Centre, Deakin University, Burwood, and Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia; Katie McGill, MPsych (Clin), DClinPsych, Centre for Brain and Mental Health Research, University of Newcastle, New South Wales, Australia; Jane Pirkis, MPsych, MAppEpid, PhD, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia; Nav Kapur, MBChB, MMedSci, MD, FRCPsych, Centre for Suicide Prevention, Manchester Academic Health Science Centre, University of Manchester, and Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK; Matthew J. Spittal, MBiostat, PhD, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Jane Pirkis
- Gregory Carter, MBBS, Cert Child Psych, PhD, FRANZCP, Centre for Brain and Mental Health Research, University of Newcastle, New South Wales, Australia; Allison Milner, BJPsych (Hons), MEpi, PhD, Population Health Strategic Research Centre, Deakin University, Burwood, and Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia; Katie McGill, MPsych (Clin), DClinPsych, Centre for Brain and Mental Health Research, University of Newcastle, New South Wales, Australia; Jane Pirkis, MPsych, MAppEpid, PhD, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia; Nav Kapur, MBChB, MMedSci, MD, FRCPsych, Centre for Suicide Prevention, Manchester Academic Health Science Centre, University of Manchester, and Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK; Matthew J. Spittal, MBiostat, PhD, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Nav Kapur
- Gregory Carter, MBBS, Cert Child Psych, PhD, FRANZCP, Centre for Brain and Mental Health Research, University of Newcastle, New South Wales, Australia; Allison Milner, BJPsych (Hons), MEpi, PhD, Population Health Strategic Research Centre, Deakin University, Burwood, and Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia; Katie McGill, MPsych (Clin), DClinPsych, Centre for Brain and Mental Health Research, University of Newcastle, New South Wales, Australia; Jane Pirkis, MPsych, MAppEpid, PhD, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia; Nav Kapur, MBChB, MMedSci, MD, FRCPsych, Centre for Suicide Prevention, Manchester Academic Health Science Centre, University of Manchester, and Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK; Matthew J. Spittal, MBiostat, PhD, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Matthew J Spittal
- Gregory Carter, MBBS, Cert Child Psych, PhD, FRANZCP, Centre for Brain and Mental Health Research, University of Newcastle, New South Wales, Australia; Allison Milner, BJPsych (Hons), MEpi, PhD, Population Health Strategic Research Centre, Deakin University, Burwood, and Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia; Katie McGill, MPsych (Clin), DClinPsych, Centre for Brain and Mental Health Research, University of Newcastle, New South Wales, Australia; Jane Pirkis, MPsych, MAppEpid, PhD, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia; Nav Kapur, MBChB, MMedSci, MD, FRCPsych, Centre for Suicide Prevention, Manchester Academic Health Science Centre, University of Manchester, and Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK; Matthew J. Spittal, MBiostat, PhD, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
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Mortality, functional and return to work outcomes of major trauma patients injured from deliberate self-harm. Injury 2017; 48:184-194. [PMID: 27839797 DOI: 10.1016/j.injury.2016.10.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 10/04/2016] [Accepted: 10/28/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Self-harm and intentional injuries represent a significant public health concern. People who survive serious injury from self-harm can experience poor outcomes that negatively impact on their daily life. The aim of this study was to investigate a cohort of major trauma patients hospitalised for self-harm in Victoria, and to identify risk factors for longer term mortality, functional recovery and return to work. METHOD 482 adult major trauma patients who were injured due to self-harm and survived to hospital discharge, and were captured by the population-based Victorian State Trauma Registry (VSTR), were included. For those with a date of injury from January 1, 2007 to December 31, 2013, demographics and injury event data, Glasgow Outcome Scale Extended (GOS-E) and return to work (RTW) outcomes at 6, 12 and 24 months post-injury were extracted from the registry. Post-discharge mortality was identified through the Victorian Registry of Births, Deaths and Marriages (BDM). Multivariable logistic regression was used to determine predictors of the GOS-E and RTW and survival analysis was used to identify predictors of mortality. RESULTS A total of 37 (7.7%) deaths occurred post-discharge. There were no clear predictors of all-cause mortality. Overall, 36% of patients reported making a good recovery at 24 months. Older age (p=0.01), transport-related methods of self-harm (p=0.02), higher Injury Severity Score (p<0.001) and having a Charlson Comorbidity Index weighting of one or more (p=0.02) were predictive of poorer functional recovery. Of patients who were working or studying prior to injury, 54% reported returning to work by 24 months post-injury. Higher Injury Severity Score was an important predictor of not returning to work (p=0.002). CONCLUSION The vast majority of major trauma patients who self-harmed and survived to hospital discharge were alive at two years post-injury, yet only half of this cohort returned to work and just over a third of patients experienced a good recovery.
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16
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Milner A, Spittal MJ, Kapur N, Witt K, Pirkis J, Carter G. Mechanisms of brief contact interventions in clinical populations: a systematic review. BMC Psychiatry 2016; 16:194. [PMID: 27277833 PMCID: PMC4898450 DOI: 10.1186/s12888-016-0896-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Accepted: 05/31/2016] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Brief Contact Interventions (BCIs) have been of increasing interest to suicide prevention clinicians, researchers and policy makers. However, there has been no systematic assessment into the mechanisms underpinning BCIs. The aim of the current paper is to provide a systematic review of the proposed mechanisms underpinning BCIs across trial studies. METHOD A systematic review was conducted of trials using BCIs (post-discharge telephone contacts; emergency or crisis cards; and postcard or letter contacts) for suicide or self-harm. Following PRISMA guidelines, we searched CENTRAL, MEDLINE, EMBASE, and the reference lists of all past reviews in the area. Secondary searches of reference lists were undertaken. RESULTS Sixteen papers provided a description of possible mechanisms which we grouped into three main areas: social support; suicide prevention literacy, and; learning alternative coping behaviours. After assessment of the studies and considering the plausibility of mechanisms, we suggest social support and improved suicide prevention literacy are the most likely mechanisms underpinning BCIs. CONCLUSION Researchers need to better articulate and measure the mechanisms they believe underpin BCIs in trial studies. Understanding more about the mechanisms of BCIs' will inform the development of future interventions for self-harm and suicide.
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Affiliation(s)
- Allison Milner
- Work, Health and Wellbeing Unit, Centre for Population Health Research, School of Health and Social Development, Deakin University, Burwood, 3125, VIC, Australia.
| | - Matthew J. Spittal
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, 3010 VIC Australia
| | - Nav Kapur
- Centre for Suicide Prevention, Centre for Mental Health and Safety, Institute of Brain Behaviour and Mental Health, The University of Manchester, Manchester, UK
| | - Katrina Witt
- Work, Health and Wellbeing Unit, Centre for Population Health Research, School of Health and Social Development, Deakin University, Burwood, 3125 VIC Australia
| | - Jane Pirkis
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, 3010 VIC Australia
| | - Greg Carter
- Centre for Brain and Mental Health Research, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia
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Quinlivan L, Cooper J, Davies L, Hawton K, Gunnell D, Kapur N. Which are the most useful scales for predicting repeat self-harm? A systematic review evaluating risk scales using measures of diagnostic accuracy. BMJ Open 2016; 6:e009297. [PMID: 26873046 PMCID: PMC4762148 DOI: 10.1136/bmjopen-2015-009297] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 09/16/2015] [Accepted: 10/21/2015] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES The 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. DESIGN Systematic review. METHODS We 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. RESULTS The 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. CONCLUSIONS It 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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Affiliation(s)
- L Quinlivan
- Centre for Mental Health and Safety, University of Manchester, Manchester, UK
| | - J Cooper
- Centre for Mental Health and Safety, University of Manchester, Manchester, UK
| | - L Davies
- Institute of Population Health, University of Manchester, Manchester, UK
| | - K Hawton
- Department of Psychiatry, Centre for Suicide Research, University, Warneford Hospital, Oxford, UK
| | - D Gunnell
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - N Kapur
- Centre for Mental Health and Safety, University of Manchester, Manchester, UK
- Manchester Mental Health and Social Care Trust, Manchester, UK
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Abstract
Abstract
Introduction:
Conducting an accurate suicide risk assessment (SRA) is no simple task as there are a number of factors that influence an individual's level of suicidality and his/her willingness to share this information. Therefore, it is imperative that practitioners adopt a systematic approach to conducting and documenting the foreseeability that a patient will commit suicide.
Methods
PubMed was used to search for articles published in MEDLINE journals using the following keywords: suicide, risk assessment, measure, scale. Randomized trials and pilot, proof-of-concept publications investigating the use of specific SRA measurements were included in the review. The scales are described based on the prevailing opinions in psychiatry from the American Psychiatric Association's Textbook of Suicide Assessment and Management (2nd ed., 2012).
Results
Although various SRA scales exist, experts in the field have repeatedly concluded that there is not any one scale that can predict who will commit suicide to any useful degree. However, when used along with the clinical interview, standardized suicide risk factor components of clinical and research scales remain crucial to gaining information often omitted by patients regarding thoughts and preparation for suicide. A summary of the most widely cited scales and approaches used in SRA is provided.
Discussion
SRA remains a challenge largely due to the fact that suicidal behavior is multifactorial. As a result, risk formulation is a process that should involve both standardized measures and detailed clinical interviews repeated over time.
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Affiliation(s)
- Megan Lotito
- (Corresponding author) Clinical Pharmacy Specialist, VA Southern Nevada Healthcare System, North Las Vegas, Nevada,
| | - Emmeline Cook
- Psychologist, VA Southern Nevada Healthcare System, North Las Vegas, Nevada
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