Risk factors for repetition of self-harm: a systematic review of prospective hospital-based studies

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dc.contributor.author Larkin, Celine
dc.contributor.author Di Blasi, Zelda
dc.contributor.author Arensman, Ella
dc.date.accessioned 2016-02-17T11:44:41Z
dc.date.available 2016-02-17T11:44:41Z
dc.date.issued 2014
dc.identifier.citation Larkin C, Di Blasi Z, Arensman E (2014) Risk Factors for Repetition of Self-Harm: A Systematic Review of Prospective Hospital-Based Studies. PLoS ONE 9(1): e84282. doi:10.1371/journal.pone.0084282
dc.identifier.volume 9 en
dc.identifier.issued 1 en
dc.identifier.issn 1932-6203
dc.identifier.uri http://hdl.handle.net/10468/2345
dc.identifier.doi 10.1371/journal.pone.0084282
dc.description.abstract Background: Self-harm entails high costs to individuals and society in terms of suicide risk, morbidity and healthcare expenditure. Repetition of self-harm confers yet higher risk of suicide and risk assessment of self-harm patients forms a key component of the health care management of self-harm patients. To date, there has been no systematic review published which synthesises the extensive evidence on risk factors for repetition. Objective: This review is intended to identify risk factors for prospective repetition of self-harm after an index self-harm presentation, irrespective of suicidal intent. Data sources: PubMed, PsychInfo and Scirus were used to search for relevant publications. We included cohort studies which examining factors associated with prospective repetition among those presenting with self-harm to emergency departments. Journal articles, abstracts, letters and theses in any language published up to June 2012 were considered. Studies were quality-assessed and synthesised in narrative form. Results: A total of 129 studies, including 329,001 participants, met our inclusion criteria. Some factors were studied extensively and were found to have a consistent association with repetition. These included previous self-harm, personality disorder, hopelessness, history of psychiatric treatment, schizophrenia, alcohol abuse/dependence, drug abuse/dependence, and living alone. However, the sensitivity values of these measures varied greatly across studies. Psychological risk factors and protective factors have been relatively under-researched but show emerging associations with repetition. Composite risk scales tended to have high sensitivity but poor specificity. Conclusions: Many risk factors for repetition of self-harm match risk factors for initiation of self-harm, but the most consistent evidence for increased risk of repetition comes from long-standing psychosocial vulnerabilities, rather than characteristics of an index episode. The current review will enhance prediction of self-harm and assist in the efficient allocation of intervention resources. en
dc.description.sponsorship Health Research Board (PhD in Health Services Research) en
dc.format.mimetype application/pdf en
dc.language.iso en en
dc.publisher Public Library of Science en
dc.rights © 2015 Larkin et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited en
dc.rights.uri http://creativecommons.org/licenses/by/4.0/ en
dc.subject Term follow-up en
dc.subject Subsequent suicidal behavior en
dc.subject Emergency department en
dc.subject Parasuicide repetition en
dc.subject Multicenter cohort en
dc.subject Predictive scales en
dc.subject Deliberate en
dc.subject Attempters en
dc.subject Repeat en
dc.subject Epidemiology en
dc.title Risk factors for repetition of self-harm: a systematic review of prospective hospital-based studies en
dc.type Article (peer-reviewed) en
dc.internal.authorcontactother Zelda Di Blasi, Applied Psychology, University College Cork, Cork, Ireland. +353-21-490-3000 Email: Z.DiBlasi@ucc.ie en
dc.internal.availability Full text available en
dc.description.version Published Version en
dc.internal.wokid WOS:000330240500013
dc.contributor.funder Health Research Board
dc.contributor.funder National Office for Suicide Prevention, Ireland
dc.description.status Peer reviewed en
dc.identifier.journaltitle PLOS ONE en
dc.internal.IRISemailaddress z.diblasi@ucc.ie en
dc.identifier.articleid e84282


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© 2015 Larkin et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited Except where otherwise noted, this item's license is described as © 2015 Larkin et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited
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