Abstract

Objective

Suicide and self-harm are widespread yet underreported. Risk assessment is key to effective self-harm and suicide prevention and management. There is contradicting evidence regarding the effectiveness of risk assessment tools in predicting self-harm and suicide risk. This systematic review examines the effect of risk assessment strategies on predicting suicide and self-harm outcomes among adult healthcare service users.

Method

Electronic and gray literature databases were searched for prospective research. Studies were screened and selected by independent reviewers. Quality and level of evidence assessments were conducted. Due to study heterogeneity, we present a narrative synthesis under three categories: (1) suicide- and self-harm-related outcomes; (2) clinician assessment of suicide and self-harm risk; and (3) healthcare utilization due to self-harm or suicide.

Results

Twenty-one studies were included in this review. The SAD PERSONS Scale was the most used tool. It outperformed the Beck Scale for Suicide Ideation in predicting hospital admissions and stay following suicide and self-harm, yet it failed to predict repeat suicide and self-harm and was not recommended for routine use. There were mixed findings relating to clinician risk assessment, with some studies recommending clinician assessment over structured tools, whilst others found that clinician assessment failed to predict future attempts and deaths.

Conclusions

There is insufficient evidence to support the use of any one tool, inclusive of clinician assessment of risk, for self-harm and suicidality. The discourse around risk assessment needs to move toward a broader discussion on the safety of patients who are at risk for self-harm and/or suicide.

• HIGHLIGHTS

• There is insufficient evidence to support using standalone risk assessment tools.

• There are mixed findings relating to clinician assessment of risk.

• Structured professional judgment is widely accepted for risk assessment.

中文翻译：

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自杀和自残风险评估：前瞻性研究的系统回顾

摘要

客观的

自杀和自残现象很普遍，但报道不足。风险评估是有效预防和管理自残和自杀的关键。关于风险评估工具在预测自残和自杀风险方面的有效性，存在相互矛盾的证据。本系统评价检验了风险评估策略对预测成人医疗保健服务使用者的自杀和自残结果的影响。

方法

搜索电子和灰色文献数据库以进行前瞻性研究。研究由独立评审员筛选和选择。进行了证据评估的质量和水平。由于研究的异质性，我们将叙述综合分为三类：（1）与自杀和自残相关的结果；(2) 临床医生对自杀和自伤风险的评估；(3) 因自残或自杀而使用医疗保健。

结果

本综述纳入了 21 项研究。悲伤的人量表是最常用的工具。它在预测自杀和自伤后的入院率和住院率方面优于贝克自杀意念量表，但未能预测重复自杀和自伤，因此不推荐常规使用。与临床医生风险评估相关的研究结果喜忧参半，一些研究建议临床医生评估优于结构化工具，而另一些研究则发现临床医生评估无法预测未来的尝试和死亡。

结论

没有足够的证据支持使用任何一种工具，包括临床医生的风险评估，用于自残和自杀。围绕风险评估的讨论需要转向更广泛的讨论，讨论有自残和/或自杀风险的患者的安全性。

• 强调

• 没有足够的证据支持使用独立的风险评估工具。

• 关于临床医生风险评估的结果不一。

• 结构化专业判断被广泛接受用于风险评估。