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PLoS One. 2014 Jan 20;9(1):e84282. doi: 10.1371/journal.pone.0084282. eCollection 2014.

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

Author information

1
National Suicide Research Foundation, Cork, Ireland.
2
School of Applied Psychology, University College Cork, Cork, Ireland.

Erratum in

  • PLoS One. 2014;9(1). doi:10.1371/annotation/b3dfd1b3-ada1-4f7e-89d4-a25ddf5d204a.

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.

PMID:
24465400
PMCID:
PMC3896350
DOI:
10.1371/journal.pone.0084282
[Indexed for MEDLINE]
Free PMC Article

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