Suicide and self-harm risk assessment: A systematic review of prospective research
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Published Version
Supplementary Material
Date
2021-07-01
Authors
Saab, Mohamad M.
Murphy, Margaret
Meehan, Elaine
Dillon, Christina B.
O'Connell, Selena
Hegarty, Josephine
Heffernan, Sinead
Greaney, Sonya
Kilty, Caroline
Goodwin, John
Journal Title
Journal ISSN
Volume Title
Publisher
Routledge - Taylor & Francis Group
Published Version
Abstract
Objective: Suicide and self-harm are widespread yet underreported. Risk assessment is key to effective self-harm and suicide prevention and management. There is contradicting evidence regarding the effectiveness of risk assessment tools in predicting self-harm and suicide risk. This systematic review examines the effect of risk assessment strategies on predicting suicide and self-harm outcomes among adult healthcare service users. Method: Electronic and gray literature databases were searched for prospective research. Studies were screened and selected by independent reviewers. Quality and level of evidence assessments were conducted. Due to study heterogeneity, we present a narrative synthesis under three categories: (1) suicide- and self-harm-related outcomes; (2) clinician assessment of suicide and self-harm risk; and (3) healthcare utilization due to self-harm or suicide. Results: Twenty-one studies were included in this review. The SAD PERSONS Scale was the most used tool. It outperformed the Beck Scale for Suicide Ideation in predicting hospital admissions and stay following suicide and self-harm, yet it failed to predict repeat suicide and self-harm and was not recommended for routine use. There were mixed findings relating to clinician risk assessment, with some studies recommending clinician assessment over structured tools, whilst others found that clinician assessment failed to predict future attempts and deaths. Conclusions: There is insufficient evidence to support the use of any one tool, inclusive of clinician assessment of risk, for self-harm and suicidality. The discourse around risk assessment needs to move toward a broader discussion on the safety of patients who are at risk for self-harm and/or suicide.
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Keywords
Risk assessment , Self-harm , Suicidal ideation , Suicide , Systematic review
Citation
Saab, M.M., Murphy, M., Meehan, E., Dillon, C. B., O'Connell, S., Hegarty, J., Heffernan, S., Greaney, S., Kilty, C., Goodwin, J., Hartigan, I., O'Brien, M., Chambers, D., Twomey, U. and O'Donovan, A. (2021) 'Suicide and self-harm risk assessment: A systematic review of prospective research', Archives of Suicide Research. doi: 10.1080/13811118.2021.1938321