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The Repeated Episodes of Self-Harm (RESH) score: A tool for predicting risk of future episodes of self-harm by hospital patients.
- Source :
-
Journal of Affective Disorders . Jun2014, Vol. 161, p36-42. 7p. - Publication Year :
- 2014
-
Abstract
- 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. [Copyright &y& Elsevier]
Details
- Language :
- English
- ISSN :
- 01650327
- Volume :
- 161
- Database :
- Academic Search Index
- Journal :
- Journal of Affective Disorders
- Publication Type :
- Academic Journal
- Accession number :
- 95721628
- Full Text :
- https://doi.org/10.1016/j.jad.2014.02.032