• Sarah Steeg, Leah Quinlivan, Rebecca Nowland, Robert Carroll, Deborah Casey, Caroline Clements, Jayne Cooper, Linda Davies, Duleeka Knipe, Jennifer Ness, Rory C O'Connor, Keith Hawton, David Gunnell, and Nav Kapur.
• Centre for Mental Health and Safety, Manchester Academic Health Science Centre, University of Manchester, Manchester, England. sarah.steeg@manchester.ac.uk.
• Bmc Psychiatry. 2018 Apr 25; 18 (1): 113.

BackgroundRisk scales are used widely in the management of patients presenting to hospital following self-harm. However, there is evidence that their diagnostic accuracy in predicting repeat self-harm is limited. Their predictive accuracy in population settings, and in identifying those at highest risk of suicide is not known.MethodWe compared the predictive accuracy of the Manchester Self-Harm Rule (MSHR), ReACT Self-Harm Rule (ReACT), SAD PERSONS Scale (SPS) and Modified SAD PERSONS Scale (MSPS) in an unselected sample of patients attending hospital following self-harm. Data on 4000 episodes of self-harm presenting to Emergency Departments (ED) between 2010 and 2012 were obtained from four established monitoring systems in England. Episodes were assigned a risk category for each scale and followed up for 6 months.ResultsThe episode-based repeat rate was 28% (1133/4000) and the incidence of suicide was 0.5% (18/3962). The MSHR and ReACT performed with high sensitivity (98% and 94% respectively) and low specificity (15% and 23%). The SPS and the MSPS performed with relatively low sensitivity (24-29% and 9-12% respectively) and high specificity (76-77% and 90%). The area under the curve was 71% for both MSHR and ReACT, 51% for SPS and 49% for MSPS. Differences in predictive accuracy by subgroup were small. The scales were less accurate at predicting suicide than repeat self-harm.ConclusionsThe scales failed to accurately predict repeat self-harm and suicide. The findings support existing clinical guidance not to use risk classification scales alone to determine treatment or predict future risk.

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