scholarly journals Predicting suicide following self-harm: systematic review of risk factors and risk scales

2016 ◽  
Vol 209 (4) ◽  
pp. 277-283 ◽  
Author(s):  
Melissa K. Y. Chan ◽  
Henna Bhatti ◽  
Nick Meader ◽  
Sarah Stockton ◽  
Jonathan Evans ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Suicide Ideation ◽  
Predictive Accuracy ◽  
Meta Analysis ◽  
Mental Healthcare ◽  
Sufficient Evidence ◽  
Predictive Values ◽  
Self Harm ◽  
The Individual

BackgroundPeople with a history of self-harm are at a far greater risk of suicide than the general population. However, the relationship between self-harm and suicide is complex.AimsTo undertake the first systematic review and meta-analysis of prospective studies of risk factors and risk assessment scales to predict suicide following self-harm.MethodWe conducted a search for prospective cohort studies of populations who had self-harmed. For the review of risk scales we also included studies examining the risk of suicide in people under specialist mental healthcare, in order to broaden the scope of the review and increase the number of studies considered. Differences in predictive accuracy between populations were examined where applicable.ResultsTwelve studies on risk factors and 7 studies on risk scales were included. Four risk factors emerged from the metaanalysis, with robust effect sizes that showed little change when adjusted for important potential confounders. These included: previous episodes of self-harm (hazard ratio (HR) = 1.68, 95% CI 1.38–2.05, K = 4), suicidal intent (HR = 2.7, 95% CI 1.91–3.81, K = 3), physical health problems (HR = 1.99, 95% CI 1.16–3.43, K = 3) and male gender (HR = 2.05, 95% CI 1.70–2.46, K = 5). The included studies evaluated only three risk scales (Beck Hopelessness Scale (BHS), Suicide Intent Scale (SIS) and Scale for Suicide Ideation). Where meta-analyses were possible (BHS, SIS), the analysis was based on sparse data and a high heterogeneity was observed. The positive predictive values ranged from 1.3 to 16.7%.ConclusionsThe four risk factors that emerged, although of interest, are unlikely to be of much practical use because they are comparatively common in clinical populations. No scales have sufficient evidence to support their use. The use of these scales, or an over-reliance on the identification of risk factors in clinical practice, may provide false reassurance and is, therefore, potentially dangerous. Comprehensive psychosocial assessments of the risks and needs that are specific to the individual should be central to the management of people who have self-harmed.

scholarly journals Examining risk factors for self-harm and suicide in LGBTQ+ young people: a systematic review protocol

BMJ Open ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. e031541
Author(s):  
A Jess Williams ◽  
Jon Arcelus ◽  
Ellen Townsend ◽  
Maria Michail
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Suicidal Ideation ◽  
Young People ◽  
Suicide Ideation ◽  
Meta Analysis ◽  
Cross Sectional ◽  
Increased Risk ◽  
Self Harm ◽  
Prospective Longitudinal

IntroductionYoung people who identify as Lesbian, Gay, Bisexual, Transgender, Queer or Questioning (LGBTQ+) are at increased risk for self-harm, suicide ideation and behaviours. However, there has yet to be a comprehensive understanding of what risk factors influence these behaviours within LGBTQ+ young people as a whole. The purpose of this systematic review is to examine risk factors associated with self-harm, suicidal ideation and behaviour in LGBTQ+) young people.Methods and analysisA systematic review will be conducted, conforming to the reporting guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement recommendations. Electronic databases (MEDLINE, Scopus, EMBASE, PsycINFO and Web of Science) will be systematically searched for cross-sectional, prospective, longitudinal, cohort and case–control designs which examine risk factors for self-harm and/or suicidal ideation and behaviour in LGBTQ+ young people (aged 12–25 years). Only studies published in English will be included. No date restrictions will be applied. Study quality assessment will be conducted using the original and modified Newcastle-Ottawa Scales. Meta-analysis or narrative synthesis will be used, dependent on findings.Ethics and disseminationThis is a systematic review of published literature and thereby ethical approval was not sought. The review will be submitted to a peer-reviewed journal, be publicly disseminated at conferences focusing on mental health, self-harm and suicide prevention. The findings will also be shared through public engagement and involvement, particularly those related to young LGBTQ+ individuals.PROSPERO registration numberCRD42019130037.

scholarly journals The prevalence and risk factors of work-related musculoskeletal disorders among adults in Ethiopia: a study protocol for extending a systematic review with meta-analysis of observational studies

2020 ◽  
Vol 9 (1) ◽  
Author(s):  
Tsiwaye Gebreyesus ◽  
Kalkidan Nigussie ◽  
Moges Gashaw ◽  
Balamurugan Janakiraman
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Musculoskeletal Disorders ◽  
Observational Studies ◽  
Meta Analysis ◽  
Work Related ◽  
Work Related Musculoskeletal Disorders ◽  
Abstract Data ◽  
Size Type ◽  
The Individual

Abstract Background Work-related musculoskeletal disorders impose a significant and most often underappreciated burden to the individual, nation, healthcare system, and society as a whole. To the best of our knowledge, there is a lack of reliable estimates on the prevalence of work-related musculoskeletal disorders in Ethiopia. The objective of this study will be to assess the existing literature on the prevalence rates and determinant factors of work-related musculoskeletal disorders in Ethiopia. Method We will search PubMed/MEDLINE, Embase, SCOPUS, PsycINFO, PEDro, and Ebsco (from January 2000 onwards). Gray literature will be identified through searching Google Scholar and dissertation databases. Observational studies reporting on the prevalence of work-related musculoskeletal disorders among adult Ethiopians will be included. The primary outcome will be the prevalence of work-related musculoskeletal disorders. Secondary outcomes will be the prevalence of any risk factors in association with work-related musculoskeletal disorders. Two reviewers will independently screen all citations, full-text articles, and abstract data. The study methodological quality (or bias) will be appraised using an appropriate tool. If feasible, we will conduct random effects meta-analysis of observational data. Subgroup analyses will be conducted to explore the potential sources of heterogeneity (e.g., gender, sample size, type of occupation). Publication bias and heterogeneity between the included studies will also be assessed and reported. Discussion This systematic review will provide a synthesis of the literature on the prevalence of work-related musculoskeletal disorders and their risk factors in Ethiopia. The results of this review could help the policymakers in occupational health and healthcare sectors in identifying priority areas for interventions in work-related musculoskeletal disorders and will also serve as a baseline for the decision-making processes of musculoskeletal health promotion, work exposure implementations, and prevention programs in workplaces. Systematic review registration PROSPERO, CRD42020164240

scholarly journals Risk factors for self-harm in prison: a systematic review and meta-analysis

2020 ◽  
Vol 7 (8) ◽  
pp. 682-691 ◽  
Author(s):  
Louis Favril ◽  
Rongqin Yu ◽  
Keith Hawton ◽  
Seena Fazel
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Meta Analysis ◽  
Self Harm

scholarly journals Predicting suicidal behaviours using clinical instruments: Systematic review and meta-analysis of positive predictive values for risk scales

2017 ◽  
Vol 210 (6) ◽  
pp. 387-395 ◽  
Author(s):  
Gregory Carter ◽  
Allison Milner ◽  
Katie McGill ◽  
Jane Pirkis ◽  
Nav Kapur ◽  
...  
Keyword(s):  
Systematic Review ◽  
High Risk ◽  
Meta Analysis ◽  
Modifiable Risk Factors ◽  
High Quality ◽  
Policy Makers ◽  
Predictive Values ◽  
Effective Interventions ◽  
Self Harm ◽  
Meta Analyses

BackgroundPrediction of suicidal behaviour is an aspirational goal for clinicians and policy makers; with patients classified as ‘high risk’ to be preferentially allocated treatment. Clinical usefulness requires an adequate positive predictive value (PPV).AimsTo identify studies of predictive instruments and to calculate PPV estimates for suicidal behaviours.MethodA systematic review identified studies of predictive instruments. A series of meta-analyses produced pooled estimates of PPV for suicidal behaviours.ResultsFor all scales combined, the pooled PPVs were: suicide 5.5% (95% CI 3.9–7.9%), self-harm 26.3% (95% CI 21.8–31.3%) and self-harm plus suicide 35.9% (95% CI 25.8–47.4%). Subanalyses on self-harm found pooled PPVs of 16.1% (95% CI 11.3–22.3%) for high-quality studies, 32.5% (95% CI 26.1–39.6%) for hospital-treated self-harm and 26.8% (95% CI 19.5–35.6%) for psychiatric in-patients.ConclusionsNo ‘high-risk’ classification was clinically useful. Prevalence imposes a ceiling on PPV. Treatment should reduce exposure to modifiable risk factors and offer effective interventions for selected subpopulations and unselected clinical populations.

scholarly journals Development and Evaluation of Models to Predict Readmission or Death After Discharge from Intensive Care 

2021 ◽  
Author(s):  
Jamie M Boyd ◽  
Matthew T James ◽  
Danny J Zuege ◽  
Henry Thomas Stelfox
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Intensive Care ◽  
Risk Prediction ◽  
Prediction Models ◽  
Meta Analysis ◽  
Local Data ◽  
Predictive Values ◽  
Risk Prediction Models ◽  
Icu Discharge

Abstract Background Patients being discharged from the intensive care unit (ICU) have variable risks of subsequent readmission or death; however, there is limited understanding of how to predict individual patient risk. We sought to derive risk prediction models for ICU readmission or death after ICU discharge to guide clinician decision-making. Methods Systematic review and meta-analysis to identify risk factors. Development and validation of risk prediction models using two retrospective cohorts of patients discharged alive from medical-surgical ICUs (n = 3 ICUs, n = 11,291 patients; n = 14 ICUs, n = 11,400 patients). Models were developed using literature and data-derived weighted coefficients. Results Sixteen variables identified from the systematic review were used to develop four risk prediction models. In the validation cohort there were 795 (7%) patients who were re-admitted to ICU and 703 (7%) patients who died after ICU discharge. The area under the curve (AUROC) for ICU readmission for the literature (0.615 [95%CI: 0.593, 0.637]) and data (0.652 [95%CI: 0.631, 0.674]) weighted models showed poor discrimination. The AUROC for death after ICU discharge for the literature (0.708 [95%CI: 0.687, 0.728]) and local data weighted (0.752 [95%CI: 0.733, 0.770]) models showed good discrimination. The negative predictive values for ICU readmission and death after ICU discharge ranged from 94%-98%. Conclusions Identifying risk factors and weighting coefficients using systematic review and meta-analysis to develop prediction models is feasible and can identify patients at low risk of ICU readmission or death after ICU discharge.

scholarly journals STUDY PROTOCOL The prevalence and risk factors of work-related musculoskeletal disorders among adults in Ethiopia: a study protocol for extending a systematic review with meta-analysis of observational studies

2020 ◽  
Author(s):  
Tsiwaye Gebreyesus ◽  
Kalkidan Nigussie ◽  
Moges Gashaw Getnet ◽  
Balamurugan Janakiraman
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Musculoskeletal Disorders ◽  
Study Protocol ◽  
Observational Studies ◽  
Meta Analysis ◽  
Grey Literature ◽  
Work Related ◽  
Work Related Musculoskeletal Disorders ◽  
The Individual

Abstract Background: Work-related musculoskeletal disorders impose a significant and most often underappreciated burden to the individual, nation, healthcare system, and society as a whole. To the best of our knowledge, there is a lack of reliable estimates on the prevalence of work-related musculoskeletal disorders in Ethiopia. The objective of this study will be to assess the existing literature on the prevalence rates and determinant factors of work-related musculoskeletal disorders in Ethiopia.Method: We will search PubMed/MEDLINE, Embase, SCOPUS, PsycINFO, PEDro and Ebsco (from January 2000 onwards). Grey literature will be identified through searching Google Scholar and dissertation databases. Observational studies reporting on the prevalence of work-related musculoskeletal disorders among adult Ethiopians will be included. The primary outcome will be the prevalence of work-related musculoskeletal disorders. Secondary outcomes will be the prevalence of any risk factors in association with work-related musculoskeletal disorders. Two reviewers will independently screen all citations, full-text articles, and abstract data. The study methodological quality (or bias) will be appraised using an appropriate tool. If feasible, we will conduct random effects meta-analysis of observational data. Subgroup analyses will be conducted to explore the potential sources of heterogeneity (e.g. gender, sample size, type of occupation).Publication bias and heterogeneity between the included studies will also be assessed and reported.Discussion: This systematic review will provide a synthesis of the literature on the prevalence of work-related musculoskeletal disorders and their risk factors in Ethiopia. The results of this review could help the policymakers in occupational health and health care sectors in identifying priority areas for interventions in work-related musculoskeletal disorders and will also serve as a baseline for the decision-making processes of musculoskeletal health promotion, work exposure implementations, and prevention programs in workplaces. Systematic review registration: PROSPERO CRD42020164240

scholarly journals Accuracy of individual and combined risk-scale items in the prediction of repetition of self-harm: multicentre prospective cohort study

BJPsych Open ◽  
2020 ◽  
Vol 7 (1) ◽  
Author(s):  
Anna Kathryn Taylor ◽  
Sarah Steeg ◽  
Leah Quinlivan ◽  
David Gunnell ◽  
Keith Hawton ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Predictive Accuracy ◽  
Sensitivity Analyses ◽  
Patient Risk ◽  
Predictive Values ◽  
Self Harm ◽  
Risk Scale

Background Individuals attending emergency departments following self-harm have increased risks of future self-harm. Despite the common use of risk scales in self-harm assessment, there is growing evidence that combinations of risk factors do not accurately identify those at greatest risk of further self-harm and suicide. Aims To evaluate and compare predictive accuracy in prediction of repeat self-harm from clinician and patient ratings of risk, individual risk-scale items and a scale constructed with top-performing items. Method We conducted secondary analysis of data from a five-hospital multicentre prospective cohort study of participants referred to psychiatric liaison services following self-harm. We tested predictive utility of items from five risk scales: Manchester Self-Harm Rule, ReACT Self-Harm Rule, SAD PERSONS, Modified SAD PERSONS, Barratt Impulsiveness Scale and clinician and patient risk estimates. Area under the curve (AUC), sensitivity, specificity, predictive values and likelihood ratios were used to evaluate predictive accuracy, with sensitivity analyses using classification-tree regression. Results A total of 483 self-harm episodes were included, and 145 (30%) were followed by a repeat presentation within 6 months. AUC of individual items ranged from 0.43–0.65. Combining best performing items resulted in an AUC of 0.56. Some individual items outperformed the scale they originated from; no items were superior to clinician or patient risk estimations. Conclusions No individual or combination of items outperformed patients’ or clinicians’ ratings. This suggests there are limitations to combining risk factors to predict risk of self-harm repetition. Risk scales should have little role in the management of people who have self-harmed.

scholarly journals Suicidal Behavior in Fibromyalgia Patients: Rates and Determinants of Suicide Ideation, Risk, Suicide, and Suicidal Attempts—A Systematic Review of the Literature and Meta-Analysis of Over 390,000 Fibromyalgia Patients

2021 ◽  
Vol 12 ◽  
Author(s):  
Mohammad Adawi ◽  
Wen Chen ◽  
Nicola Luigi Bragazzi ◽  
Abdulla Watad ◽  
Dennis McGonagle ◽  
...  
Keyword(s):  
Mental Health ◽  
Risk Factors ◽  
Systematic Review ◽  
Suicidal Behavior ◽  
Suicide Ideation ◽  
Global Mental Health ◽  
Meta Analysis ◽  
Statistical Significance ◽  
Poor Sleep ◽  
Clinical Trial Registration

Background: Suicide is a leading cause of death worldwide, affecting ~800,000 people every year. Fibromyalgia is an extremely prevalent rheumatic disease with a predisposition for comorbid anxiety and depression, which are known risk factors for suicidal behavior. Suicidality and relevant risk factors for suicidal behavior have not been thoroughly studied in patients with fibromyalgia.Objectives: To investigate the risk of suicidal ideation and attempts in patients with fibromyalgia.Methods: A systematic review and meta-analysis was conducted and reported according to the “Preferred Reporting Items for Systematic reviews and Meta-analyses” (PRISMA) standards. Also, the gray literature was extensively searched.Results: Thirteen studies were included in the present systematic review and meta-analysis, including 394,087 fibromyalgia patients. Sample size ranged from 44 to 199,739 subjects, mean age ranged from 45.8 to 54.5 years while the female percentage with fibromyalgia ranged from 17.1 to 100.0%. The overall suicide ideation prevalence was 29.57% (95%CI 1.84–72.07), with an OR 9.12 of (95%CI 1.42–58.77), ranging from 2.34 (95%CI 1.49–3.66) to 26.89 (95%CI 5.72–126.42). Pooled suicide attempt prevalence was 5.69% [95%CI 1.26–31.34], with an OR of 3.12 [95%CI 1.37–7.12]. Suicide risk was higher with respect to the general population with an OR of 36.77 (95%CI 15.55–96.94), as well as suicide events with an HR of 1.38 (95%CI 1.17–1.71). Determinants of suicidality were found to be: employment status, disease severity, obesity and drug dependence, chronic pain and co-morbidities, in particular depression, anxiety, poor sleep, and global mental health. However, in some cases, after adjusting for psychiatric conditions, the threshold of statistical significance was not achieved.Conclusion: Fibromyalgia patients are particularly prone to suicide, in terms of ideation, attempt, risk and events, warranting a pre-emptive screening of their mental health status. Given the few studies available, the high amount of heterogeneity, the evidence of publications bias and the lack of statistical significance when adjusting for underlying psychiatric co-morbidities, further high-quality studies should be conducted.Clinical Trial Registration:ClinicalTrial.gov, identifier 10.17605/OSF.IO/Y4BUE.

Attachment Organization in Suicide Prevention Research

Crisis ◽  
2014 ◽  
Vol 35 (1) ◽  
pp. 60-66 ◽  
Author(s):  
Amanda Venta ◽  
Carla Sharp
Keyword(s):  
Risk Factors ◽  
Suicidal Ideation ◽  
Suicide Attempt ◽  
Interpersonal Relationships ◽  
Suicide Ideation ◽  
Suicide Attempts ◽  
Critical Role ◽  
Self Report ◽  
Future Research ◽  
Self Harm

Background: Identifying risk factors for suicide-related thoughts and behaviors (SRTB) is essential among adolescents in whom SRTB remain a leading cause of death. Although many risk factors have already been identified, influential theories now suggest that the domain of interpersonal relationships may play a critical role in the emergence of SRTB. Because attachment has long been seen as the foundation of interpersonal functioning, we suggest that attachment insecurity warrants attention as a risk factor for SRTB. Aims: This study sought to explore relations between attachment organization and suicidal ideation, suicide attempts, and self-harm in an inpatient adolescent sample, controlling for demographic and psychopathological covariates. Method: We recruited 194 adolescents from an inpatient unit and assigned them to one of four attachment groups (secure, preoccupied, dismissing, or disorganized attachment). Interview and self-report measures were used to create four variables reflecting the presence or absence of suicidal ideation in the last year, single lifetime suicide attempt, multiple lifetime suicide attempts, and lifetime self-harm. Results: Chi-square and regression analyses did not reveal significant relations between attachment organization and SRTB, although findings did confirm previously established relations between psychopathology and SRTB, such that internalizing disorder was associated with increased self-harm, suicide ideation, and suicide attempt and externalizing disorder was associated with increased self-harm. Conclusion: The severity of this sample and methodological differences from previous studies may explain the nonsignificant findings. Nonsignificant findings may indicate that the relation between attachment organization and SRTB is moderated by other factors that should be explored in future research.

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