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Helped to interpret the analyses and write the report Conflict of interest statements: NK and TK were chair and facilitator, respectively, of NICE clinical guideline 133 on self-harm (longer term management). The other authors were members of the guideline development group. NK sits on the Department of Health's (England) National Suicide Prevention Strategy Advisory Group. Some authors were also co-authors on primary studies included in the review.Role of funding source: This study was funded in part by NICE during the development of the NICE guideline for self-harm: longer term management Ethics committee approval: Not applicable PRISMA statement: Please refer to online appendix. AbstractBackground: Suicide and self-harm are major public health problems. People 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. We have undertaken the first systematic review and meta-analysis of prospective studies of risk factors and risk assessment scales to predict suicide following self-harm, undertaken as part of the development of the National Institute for Health and Care Excellence (NICE) guideline.

The study finds that the prevalence of severe social withdrawal in Hong Kong is comparable to that in Japan. Both groups with withdrawal behaviors for more or less than 6 months share similar characteristics and are related to other contemporary youth issues, for example, compensated dating and self-injury behavior. The self-perceived non-problematic group appears to be a distinct group and the withdrawal behaviors of its members may be discretionary.

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