Risk of death by suicide following self-harm presentations to healthcare: development and validation of a multivariable clinical prediction rule (OxSATS)
<strong>Background </strong>Assessment of suicide risk in individuals who have self-harmed is common in emergency departments, but is often based on tools developed for other purposes. <br><strong> Objective </strong>We developed and validated a predictive model for sui...
| Main Authors: | , , , , , , , , , |
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| Format: | Journal article |
| Language: | English |
| Published: |
BMJ Publishing Group
2023
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| _version_ | 1797110798421590016 |
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| author | Fazel, S Vazquez-Montes, MDLA Molero, Y Runeson, B D'Onofrio, BM Larsson, H Lichtenstein, P Walker, J Sharpe, M Fanshawe, TR |
| author_facet | Fazel, S Vazquez-Montes, MDLA Molero, Y Runeson, B D'Onofrio, BM Larsson, H Lichtenstein, P Walker, J Sharpe, M Fanshawe, TR |
| author_sort | Fazel, S |
| collection | OXFORD |
| description | <strong>Background </strong>Assessment of suicide risk in individuals who have self-harmed is common in emergency departments, but is often based on tools developed for other purposes.
<br><strong>
Objective </strong>We developed and validated a predictive model for suicide following self-harm.
<br><strong>
Methods </strong>We used data from Swedish population-based registers. A cohort of 53 172 individuals aged 10+ years, with healthcare episodes of self-harm, was split into development (37 523 individuals, of whom 391 died from suicide within 12 months) and validation (15 649 individuals, 178 suicides within 12 months) samples. We fitted a multivariable accelerated failure time model for the association between risk factors and time to suicide. The final model contains 11 factors: age, sex, and variables related to substance misuse, mental health and treatment, and history of self-harm. Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis guidelines were followed for the design and reporting of this work.
<br><strong>
Findings </strong>An 11-item risk model to predict suicide was developed using sociodemographic and clinical risk factors, and showed good discrimination (c-index 0.77, 95% CI 0.75 to 0.78) and calibration in external validation. For risk of suicide within 12 months, using a 1% cut-off, sensitivity was 82% (75% to 87%) and specificity was 54% (53% to 55%). A web-based risk calculator is available (Oxford Suicide Assessment Tool for Self-harm or OxSATS).
<br><strong>
Conclusions </strong>OxSATS accurately predicts 12-month risk of suicide. Further validations and linkage to effective interventions are required to examine clinical utility.
<br><strong>
Clinical implications </strong>Using a clinical prediction score may assist clinical decision-making and resource allocation. |
| first_indexed | 2024-03-07T07:59:51Z |
| format | Journal article |
| id | oxford-uuid:faf3782b-8706-4607-a2c7-aa83fdbeb1d1 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T07:59:51Z |
| publishDate | 2023 |
| publisher | BMJ Publishing Group |
| record_format | dspace |
| spelling | oxford-uuid:faf3782b-8706-4607-a2c7-aa83fdbeb1d12023-09-14T17:37:37ZRisk of death by suicide following self-harm presentations to healthcare: development and validation of a multivariable clinical prediction rule (OxSATS)Journal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:faf3782b-8706-4607-a2c7-aa83fdbeb1d1EnglishSymplectic ElementsBMJ Publishing Group2023Fazel, SVazquez-Montes, MDLAMolero, YRuneson, BD'Onofrio, BMLarsson, HLichtenstein, PWalker, JSharpe, MFanshawe, TR<strong>Background </strong>Assessment of suicide risk in individuals who have self-harmed is common in emergency departments, but is often based on tools developed for other purposes. <br><strong> Objective </strong>We developed and validated a predictive model for suicide following self-harm. <br><strong> Methods </strong>We used data from Swedish population-based registers. A cohort of 53 172 individuals aged 10+ years, with healthcare episodes of self-harm, was split into development (37 523 individuals, of whom 391 died from suicide within 12 months) and validation (15 649 individuals, 178 suicides within 12 months) samples. We fitted a multivariable accelerated failure time model for the association between risk factors and time to suicide. The final model contains 11 factors: age, sex, and variables related to substance misuse, mental health and treatment, and history of self-harm. Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis guidelines were followed for the design and reporting of this work. <br><strong> Findings </strong>An 11-item risk model to predict suicide was developed using sociodemographic and clinical risk factors, and showed good discrimination (c-index 0.77, 95% CI 0.75 to 0.78) and calibration in external validation. For risk of suicide within 12 months, using a 1% cut-off, sensitivity was 82% (75% to 87%) and specificity was 54% (53% to 55%). A web-based risk calculator is available (Oxford Suicide Assessment Tool for Self-harm or OxSATS). <br><strong> Conclusions </strong>OxSATS accurately predicts 12-month risk of suicide. Further validations and linkage to effective interventions are required to examine clinical utility. <br><strong> Clinical implications </strong>Using a clinical prediction score may assist clinical decision-making and resource allocation. |
| spellingShingle | Fazel, S Vazquez-Montes, MDLA Molero, Y Runeson, B D'Onofrio, BM Larsson, H Lichtenstein, P Walker, J Sharpe, M Fanshawe, TR Risk of death by suicide following self-harm presentations to healthcare: development and validation of a multivariable clinical prediction rule (OxSATS) |
| title | Risk of death by suicide following self-harm presentations to healthcare: development and validation of a multivariable clinical prediction rule (OxSATS) |
| title_full | Risk of death by suicide following self-harm presentations to healthcare: development and validation of a multivariable clinical prediction rule (OxSATS) |
| title_fullStr | Risk of death by suicide following self-harm presentations to healthcare: development and validation of a multivariable clinical prediction rule (OxSATS) |
| title_full_unstemmed | Risk of death by suicide following self-harm presentations to healthcare: development and validation of a multivariable clinical prediction rule (OxSATS) |
| title_short | Risk of death by suicide following self-harm presentations to healthcare: development and validation of a multivariable clinical prediction rule (OxSATS) |
| title_sort | risk of death by suicide following self harm presentations to healthcare development and validation of a multivariable clinical prediction rule oxsats |
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