Risk of death by suicide following self-harm presentations to healthcare: development and validation of a multivariable clinical prediction rule (OxSATS).

Autor:	Fazel S; Psychiatry, University of Oxford, Oxford, UK seena.fazel@psych.ox.ac.uk.; Oxford Health NHS Foundation Trust, Oxford, UK., Vazquez-Montes MDLA; Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, UK., Molero Y; Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden.; Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden., Runeson B; Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.; Stockholm Health Care Services, Stockholm, Sweden., D'Onofrio BM; Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden.; Department of Psychological and Brain Sciences, Indiana University Bloomington, Bloomington, Indiana, USA., Larsson H; Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden.; School of Medical Sciences, Örebro Universitet, Orebro, Sweden., Lichtenstein P; Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden., Walker J; Psychological Medicine Research Department of Psychiatry, University of Oxford, Oxford, UK., Sharpe M; Psychological Medicine Research Department of Psychiatry, University of Oxford, Oxford, UK., Fanshawe TR; Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, UK.
Jazyk:	angličtina
Zdroj:	BMJ mental health [BMJ Ment Health] 2023 May; Vol. 26 (1).
DOI:	10.1136/bmjment-2023-300673
Abstrakt:	Background: 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. Objective: We developed and validated a predictive model for suicide following self-harm. Methods: 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. Findings: 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). Conclusions: OxSATS accurately predicts 12-month risk of suicide. Further validations and linkage to effective interventions are required to examine clinical utility. Clinical Implications: Using a clinical prediction score may assist clinical decision-making and resource allocation. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.)
Databáze:	MEDLINE
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