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Predicting future self-harm or suicide in adolescents: a systematic review of risk assessment scales/tools.

ABSTRACT: OBJECTIVE:This systematic review aimed to evaluate the ability of risk tools to predict the future episodes of suicide/self-harm in adolescents. DESIGN:Systematic review. DATA SOURCES:MEDLINE, EMBASE, CINAHL and PsycINFO were searched from inception to 3 March 2018. ELIGIBILITY CRITERIA FOR SELECTING STUDIES:Cohort studies, case-control studies and randomised controlled trials of adolescents aged 10-25 who had undergone risk assessment in a clinical setting following an episode of self-harm were included. DATA EXTRACTION AND SYNTHESIS:Two independent reviewers extracted data and assessed risk of bias. Data were grouped by tool and narrative synthesis undertaken, with studies appraised using a checklist combining the QUIPS (Quality In Prognosis Studies) and QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies) tools. RESULTS:Of the 17 137 articles initially identified, 11 studies evaluating 10 separate tools were included. The studies varied in setting, population and outcome measure. The majority of the studies were rated as having an unclear risk of bias, and meta-analysis was not possible due to high variability between studies.The ability of the tools to correctly identify those adolescents going on to make a self-harm/suicide attempt ranged from 27% (95% CI 10.7% to 50.2%) to 95.8% (95% CI 78.9% to 99.9%). A variety of metrics were provided for 1-10 points increases in various tools, for example, odds and HRs. CONCLUSIONS:This systematic review is the first to explore the use of assessment tools in adolescents. The predictive ability of these tools varies greatly. No single tool is suitable for predicting a higher risk of suicide or self-harm in adolescent populations. PROSPERO REGISTRATION NUMBER:CRD42017058686.

SUBMITTER: Harris IM

PROVIDER: S-EPMC6731844 | biostudies-other | 2019 Sep

REPOSITORIES: biostudies-other

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Predicting future self-harm or suicide in adolescents: a systematic review of risk assessment scales/tools.

Harris Isobel Marion IM Beese Sophie S Moore David D

BMJ open 20190906 9

<h4>Objective</h4>This systematic review aimed to evaluate the ability of risk tools to predict the future episodes of suicide/self-harm in adolescents.<h4>Design</h4>Systematic review.<h4>Data sources</h4>MEDLINE, EMBASE, CINAHL and PsycINFO were searched from inception to 3 March 2018.<h4>Eligibility criteria for selecting studies</h4>Cohort studies, case-control studies and randomised controlled trials of adolescents aged 10-25 who had undergone risk assessment in a clinical setting following ...[more]

PMID: 31494608

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Project description:AimsSuicide accounts for 2.2% of all years of life lost worldwide. We aimed to establish whether infectious epidemics are associated with any changes in the incidence of suicide or the period prevalence of self-harm, or thoughts of suicide or self-harm, with a secondary objective of establishing the frequency of these outcomes.MethodsIn this systematic review and meta-analysis, MEDLINE, Embase, PsycINFO and AMED were searched from inception to 9 September 2020. Studies of infectious epidemics reporting outcomes of (a) death by suicide, (b) self-harm or (c) thoughts of suicide or self-harm were identified. A random-effects model meta-analysis for the period prevalence of thoughts of suicide or self-harm was conducted.ResultsIn total, 1354 studies were screened with 57 meeting eligibility criteria, of which 7 described death by suicide, 9 by self-harm, and 45 thoughts of suicide or self-harm. The observation period ranged from 1910 to 2020 and included epidemics of Spanish Flu, severe acute respiratory syndrome, human monkeypox, Ebola virus disease and coronavirus disease 2019 (COVID-19). Regarding death by suicide, data with a clear longitudinal comparison group were available for only two epidemics: SARS in Hong Kong, finding an increase in suicides among the elderly, and COVID-19 in Japan, finding no change in suicides among children and adolescents. In terms of self-harm, five studies examined emergency department attendances in epidemic and non-epidemic periods, of which four found no difference and one showed a reduction during the epidemic. In studies of thoughts of suicide or self-harm, one large survey showed a substantial increase in period prevalence compared to non-epidemic periods, but smaller studies showed no difference. As a secondary objective, a meta-analysis of thoughts of suicide and self-harm found that the pooled prevalence was 8.0% overall (95% confidence interval (CI) 5.2-12.0%; 14 820 of 99 238 cases in 24 studies) over a time period of between seven days and six months. The quality assessment found 42 studies were of high quality, nine of moderate quality and six of high quality.ConclusionsThere is little robust evidence on the association of infectious epidemics with suicide, self-harm and thoughts of suicide or self-harm. There was an increase in suicides among the elderly in Hong Kong during SARS and no change in suicides among young people in Japan during COVID-19, but it is unclear how far these findings may be generalised. The development of up-to-date self-harm and suicide statistics to monitor the effect of the current pandemic is an urgent priority.

Project description:ImportanceSelf-harm is a risk factor for suicide in adolescents, with the prevalence highest in young people in group and residential care programs. Although no established risk factors for self-harm exist, adolescents who self-harm may have decreased pain sensitivity, but this has not been systematically investigated.ObjectiveTo assess somatosensory function using quantitative sensory testing (QST) in children and adolescents living in care grouped by the number of episodes of self-harm in the past year and compare their somatosensory profiles with community control participants to investigate associations with the incidence or frequency of self-harm.Design, setting, and participantsRecruitment for this cross-sectional study began January 2019 and ended March 2020. Exclusion criteria included intellectual disability (intelligence quotient <70), autism spectrum disorder, or recent serious injury. Children and adolescents aged 12 to 17 years with no underlying health conditions were recruited from local authority residential care settings in Glasgow, UK, and schools and youth groups in London and Glasgow, UK. The volunteer sample of 64 participants included adolescents ages 13 to 17 years (34 [53%] females; 50 [78%] living in residential care; mean [SD] age, 16.34 [1.01] years) with varying incidents of self-harm in the past year (no episodes, 31 [48%]; 1-4 episodes, 12 [19%]; and ≥5 episodes, 2 [33%]).ExposuresParticipants were tested using a standardized QST protocol to establish baseline somatosensory function.Main outcomes and measuresAssociations between somatosensory sensitivity, incidence and frequency of self-harm, residential status, age, gender, and prescription medication were calculated. Secondary outcomes assessed whether self-harm was associated with specific types of tests (ie, painful or nonpainful).ResultsA total of 64 participants ages 13 to 17 years completed testing (mean [SD] age, 16.3 [1.0] years; 34 [53%.] females and 30 [47%] males; 50 [78%] living in group homes). Adolescents with 5 or more self-harm incidences showed significant pain hyposensitivity compared with community control participants after adjusting for age, gender, and prescription drug use (SH group with 5 or more episodes vs control: -1.03 [95% CI, -1.47 to -0.60]; P < .001). Hyposensitivity also extended to nonpainful stimuli, similarly adjusted (SH group with 5 or more episodes vs control: -1.73; 95% CI, -2.62 to -0.84; P < .001). Pressure pain threshold accounted for most of the observed variance (31.1% [95% CI, 10.5% to 44.7%]; P < .001).Conclusions and relevanceThe findings of this study suggest that sensory hyposensitivity is a phenotype of Adolescents who self-harm and that pressure pain threshold has clinical potential as a quick, inexpensive, and easily interpreted test to identify adolescents at increased risk of repeated self-harm.

Project description:Background: Self-harm and suicide in children and adolescents are of serious consequence and increase during the adolescent years. Consequently, there is need for interventions that prevent such behaviour. The objective of this paper: to evaluate the effects of interventions preventing self-harm and suicide in children and adolescents in an overview of systematic reviews. Methods: We conducted an overview of systematic reviews (OoO). We included reviews evaluating any preventive or therapeutic intervention. The methodological quality of the included reviews was assessed independently, and data was extracted by two reviewers. We report the review findings descriptively. The certainty of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE). Results: Moderate certainty evidence suggests that school-based interventions prevent suicidal ideation and attempts short term, and possibly suicide attempts long term. The effects of community-based interventions following suicide clusters and local suicide plans are unknown, as are the benefits and harms of screening young people for suicide risk. The effects of most interventions targeting children and adolescents with known self-harm are unknown. However, low certainty evidence suggests that dialectical behavioural therapy and developmental group therapy are equally as effective on repetition of self-harm as enhanced treatment as usual. Conclusions: Research on several recommended practices, such as local suicide plans, prevention of suicide clusters and approaches to risk assessment, is lacking. When such interventions are implemented, the effects should be closely evaluated. There is also need for more research on treatment of repeated self-harm. Further research should include long term follow-up, and investigate possible adverse effects. In prevention of self-harm and suicide in children and adolescents, policy makers and health providers should consider evidence from population-based studies with mixed-age samples, adult samples, and studies on conditions associated with self-harm and/or suicidality, such as depression and psychosis. PROSPERO registration: CRD42019117942 08/02/19.

Project description:BackgroundSuicidal thoughts and non-suicidal self-harm are common in adolescents and are strongly associated with suicide attempts. We aimed to identify predictors of future suicide attempts in these high-risk groups.MethodsParticipants were from the Avon Longitudinal Study of Parents and Children, a population-based birth cohort study in the UK. The sample included 456 adolescents who reported suicidal thoughts and 569 who reported non-suicidal self-harm at 16 years of age. Logistic regression analyses were used to explore associations between a wide range of prospectively recorded risk factors and future suicide attempts, assessed at the age of 21 years.Findings38 (12%) of 310 participants with suicidal thoughts and 46 (12%) of 380 participants who had engaged in non-suicidal self-harm reported having attempted suicide for the first time by the follow-up at 21 years of age. Among participants with suicidal thoughts, the strongest predictors of transition to attempts were non-suicidal self-harm (odds ratio [OR] 2·78, 95% CI 1·35-5·74; p=0·0059), cannabis use (2·61, 1·11-6·14; p=0·029), other illicit drug use (2·47, 1·02-5·96; p=0·045), exposure to self-harm (family 2·03, 0·93-4·44, p=0·076; friend 1·85, 0·93-3·69, p=0·081), and higher levels of the personality type intellect/openness (1·62, 1·06-2·46; p=0·025). Among participants with non-suicidal self-harm at baseline, the strongest predictors were cannabis use (OR 2·14, 95% CI 1·04-4·41; p=0·038), other illicit drug use (2·17, 1·10-4·27; p=0·025), sleep problems (waking in the night 1·91, 0·95-3·84, p=0·069; insufficient sleep 1·97, 1·02-3·81, p=0·043), and lower levels of the personality type extraversion (0·71, 0·49-1·03; p=0·068).InterpretationMost adolescents who think about suicide or engage in non-suicidal self-harm will not make an attempt on their life. Many commonly cited risk factors were not associated with transition to suicide attempt among these high-risk groups. Our findings suggest that asking about substance use, non-suicidal self-harm, sleep, personality traits, and exposure to self-harm could inform risk assessments, and might help clinicians to identify which adolescents are at greatest risk of attempting suicide in the future.FundingAmerican Foundation for Suicide Prevention, National Institute for Health Research Biomedical Research Centre at the University Hospitals Bristol National Health Service Foundation Trust, and the University of Bristol.

Project description:BackgroundSuicide is a leading cause of death globally, and there has been a rapid growth in the use of new technologies such as mobile health applications (apps) to help identify and support those at risk. However, it is not known whether these apps are evidence-based, or indeed contain potentially harmful content. This review examines the concordance of features in publicly available apps with current scientific evidence of effective suicide prevention strategies.MethodsApps referring to suicide or deliberate self-harm (DSH) were identified on the Android and iOS app stores. Systematic review methodology was employed to screen and review app content. App features were labelled using a coding scheme that reflected the broad range of evidence-based medical and population-based suicide prevention interventions. Best-practice for suicide prevention was based upon a World Health Organization report and supplemented by other reviews of the literature.ResultsOne hundred and twenty-three apps referring to suicide were identified and downloaded for full review, 49 of which were found to contain at least one interactive suicide prevention feature. Most apps focused on obtaining support from friends and family (n = 27) and safety planning (n = 14). Of the different suicide prevention strategies contained within the apps, the strongest evidence in the literature was found for facilitating access to crisis support (n = 13). All reviewed apps contained at least one strategy that was broadly consistent with the evidence base or best-practice guidelines. Apps tended to focus on a single suicide prevention strategy (mean = 1.1), although safety plan apps provided the opportunity to provide a greater number of techniques (mean = 3.9). Potentially harmful content, such as listing lethal access to means or encouraging risky behaviour in a crisis, was also identified.DiscussionMany suicide prevention apps are available, some of which provide elements of best practice, but none that provide comprehensive evidence-based support. Apps with potentially harmful content were also identified. Despite the number of apps available, and their varied purposes, there is a clear need to develop useful, pragmatic, and multifaceted mobile resources for this population. Clinicians should be wary in recommending apps, especially as potentially harmful content can be presented as helpful. Currently safety plan apps are the most comprehensive and evidence-informed, for example, "Safety Net" and "Mood-Tools--Depression Aid".

Dataset Information

Predicting future self-harm or suicide in adolescents: a systematic review of risk assessment scales/tools.

Publications

Predicting future self-harm or suicide in adolescents: a systematic review of risk assessment scales/tools.

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