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J Affect Disord. 2014 Jun;161:36-42. doi: 10.1016/j.jad.2014.02.032. Epub 2014 Mar 12.

The Repeated Episodes of Self-Harm (RESH) score: A tool for predicting risk of future episodes of self-harm by hospital patients.

Author information

1
Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC 3010, Australia. Electronic address: m.spittal@unimelb.edu.au.
2
Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC 3010, Australia.
3
Department of Health Policy and Management, Harvard School of Public Health, MA, United States.
4
Centre for Translational Neuroscience and Mental Health (CTNMH), Faculty of Health and Medicine, University of Newcastle, NSW, Australia.

Abstract

BACKGROUND:

Repetition of hospital-treated deliberate self-harm is common. Several recent studies have used emergency department data to develop clinical tools to assess risk of self-harm or suicide. Longitudinal, linked inpatient data is an alternative source of information.

METHODS:

We identified all individuals admitted to hospital for deliberate self-harm in two Australian states (~350 hospitals). The outcome of interest was a repeated episode of self-harm (non-fatal or fatal) within 6 months. Logistic regression was used to identify a set of predictors of repetition. A risk calculator (RESH: Repeated Episodes of Self-Harm) was derived directly from model coefficients.

RESULTS:

There were 84,659 episodes of self-harm during the study period. Four variables - number of prior episodes, time between episodes, prior psychiatric diagnoses and recent psychiatric hospital stay - strongly predicted repetition. The RESH score showed good discrimination (AUC=0.75) and had high specificity. Patients with scores of 0-3 had 14% risk of repeat episodes, whereas patients with scores of 20-25 had over 80% risk. We identified five thresholds where the RESH score could be used for prioritising interventions.

LIMITATIONS:

The trade-off of a highly specific test is that the instrument has poor sensitivity. As a consequence, the RESH score cannot be used reliably for "ruling out" those who score below the thresholds.

CONCLUSIONS:

The RESH score could be useful for prioritising patients to interventions to reduce readmission for deliberate self-harm. The five thresholds, representing the continuum from low to high risk, enable a stepped care model of overlapping or sequential interventions to be deployed to patients at risk of self-harm.

KEYWORDS:

Deliberate self-harm; Epidemiology; Inpatient treatment; Risk assessment; Suicide

PMID:
24751305
DOI:
10.1016/j.jad.2014.02.032
[Indexed for MEDLINE]
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