Risk assessment scales to predict risk of hospital treated repeat self-harm: A cost-effectiveness modelling analysis

Quinlivan, Leah; Steeg, Sarah; Elvidge, Jamie; Nowland, Rebecca; Davies, Linda; Hawton, Keith; Gunnell, David; Kapur, Navneet

doi:10.1016/j.jad.2019.02.036

Cited by 11 publications

(8 citation statements)

References 36 publications

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“…However, this cut-off is not appropriate to be used in the context of treatment decisions or classifying autistic/possibly autistic people as high or low risk of future suicide attempts in clinical practice. The reasons being that rst, this cut-off has been calculated in the context of research and past (not future) suicide attempt(s), and second, there is strong evidence that short suicide risk assessment tools like the SBQ-ASC and SBQ-R do not help clinicians correctly identify who will likely attempt suicide in the future [54][55][56][57].…”

Section: Discussionmentioning

confidence: 99%

Development and Validation of the Suicide Behaviours Questionnaire – Autism Spectrum Conditions in Autistic, Possibly Autistic and Non-Autistic Adults.

Cassidy

Bradley

Cogger-Ward

et al. 2020

Preprint

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Background: Autistic people and those with high autistic traits are at high risk of experiencing suicidality. Yet, there are no suicidality assessment tools developed or validated for these groups.Methods: A widely used and validated suicidality assessment tool developed for the general population (SBQ-R), was adapted using feedback from autistic adults. The adapted tool was refined through 9 interviews, and an online survey with 251 autistic adults, to establish clarity and relevance of the items. Subsequently, 308 autistic, 113 possibly autistic, and 268 non-autistic adults completed the adapted tool online, alongside self-report measures of autistic traits (AQ), camouflaging autistic traits (CAT-Q), depression (PHQ-9), anxiety (ASA-A), thwarted belongingness and perceived burdensomeness (INQ-15), lifetime non-suicidal self-injury, and the original version of the suicidality assessment tool (SBQ-R). Analyses explored the appropriateness and measurement properties of the adapted tool between the groups.Results: There was evidence in support of content validity, structural validity, internal consistency, convergent and divergent validity, test retest validity, sensitivity and specificity (for distinguishing those with or without lifetime experience of suicide attempt), and hypothesis testing of the adapted tool (SBQ-ASC) in each group. The structure of the SBQ-ASC was equivalent between autistic and possibly autistic adults, regardless of gender, or use of visual aids to help quantify abstract rating scales.Limitations: The samples involved in the development and validation of the adapted tool were largely female, and largely diagnosed as autistic in adulthood, which is not representative of the wider autistic population. The SBQ-ASC has been developed for use in research and is not recommended to assess risk of future suicide attempts and/or self-harm.Conclusions: The SBQ-ASC is a brief self-report suicidality assessment tool, developed and validated with and for autistic adults, without co-occurring intellectual disability. The SBQ-ASC is appropriate for use in research to identify suicidal thoughts and behaviours in autistic and possibly autistic people, and model associations with risk and protective factors.

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Section: Discussionmentioning

confidence: 99%

Development and Validation of the Suicide Behaviours Questionnaire – Autism Spectrum Conditions in Autistic, Possibly Autistic and Non-Autistic Adults.

Cassidy

Bradley

Cogger-Ward

et al. 2020

Preprint

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“…The prediction of self-harm using self-harm risk scales in emergency departments is poor and not cost-effective. 42,43 Implications for research and practice This review highlights the lack of evidence on the GP role in self-harm management. The authors believe that the role of the GP is multidimensional, but characterised by time constraints.…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

Role of the GP in the management of patients with self-harm behaviour: a systematic review

et al. 2020

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BackgroundSelf-harm is a serious risk factor for suicide, a major public health concern, and a significant burden on the NHS. Rates of self-harm presentation in primary care are rising and GPs interact with patients both before and after they have self-harmed. There is significant public and political interest in reducing rates of self-harm, but there has been no robust synthesis of the existing literature on the role of GPs in the management of patients who self-harm.AimThis study aimed to explore the role of the GP in the management of patients with self-harm behaviour.Design and settingA systematic review and narrative synthesis of primary care literature.MethodThis systematic review was conducted and is reported in line with PRISMA guidance. Electronic databases systematically searched were MEDLINE, PsycINFO, EMBASE, CINAHL, Web of Science, and AMED. Two independent reviewers conducted study screening and selection, data extraction, and quality appraisal of all included studies. Thematic analysis was conducted.ResultsFrom 6976 unique citations, 12 studies met eligibility criteria and were included. These 12 studies, published from 1997–2016, of 789 GPs/family medicine physicians from Europe, the US, and Australia were of good methodological quality. Five themes were identified for facilitating GP management of self-harm: GP training, improved communication, service provision, clinical guidelines, and young people. Four barriers for GP management of self-harm were identified: assessment, service provision, local, and systemic factors.ConclusionGPs recognise self-harm as a serious risk factor for suicide, but some feel unprepared for managing self-harm. The role of the GP is multidimensional and includes frontline assessment and treatment, referral to specialist care, and the provision of ongoing support.

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“…Another English study using cohort data from three hospitals reported a relative risk of 0.82 using instrumental variables (IV) methodology, but cautioned the estimate could be biased because of limitations in the application of the IV methodology (15). A previous modelling analysis, looking at ‘risk scales’ as part of a hospital assessment process, assumed a relative risk of 0.8 for individuals receiving a psychosocial assessment (17). In our sensitivity analysis the probability of repeat self-harm following psychosocial assessment needs to be 0.13 or lower (equivalent to a relative risk of 0.73 for repeat self-harm) for the intervention to be considered cost-effective from a health system perspective at a cost per QALY threshold of £20,000.…”

Section: Discussionmentioning

confidence: 99%

“…One exception was for the probability of repeat self-harm after psychosocial assessment. In this case in sensitivity analyses we ensured that the lower estimate of effect reflected more conservative values reported in the literature (15–17).…”

Section: Methodsmentioning

confidence: 99%

Cost-effectiveness of psychosocial assessment for individuals who present to hospital following self-harm in England: a model-based retrospective analysis

McDaid

Park

Tsiachristas

et al. 2021

Preprint

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Aims There are substantial costs to health care systems and society associated with self-harm. Moreover, individuals who have presented to hospital following self-harm have a much higher risk of suicide within the following year compared to the general population. National guidance in England recommends psychosocial assessment when presenting to hospital following self-harm but adherence to this guidance is variable. There is some limited evidence suggesting that psychosocial assessment is associated with lower risk of subsequent presentation to hospital for self-harm. The aim of this study was to assess the potential cost-effectiveness of psychosocial assessment for hospital-presenting self-harm in England compared to no assessment. Methods. We constructed a three-state four-cycle Markov model to assess the cost-effectiveness of psychosocial assessment after self-harm compared with no assessment over two years. Data on risk of subsequent self-harm and hospital costs of treating different types of self-harm were drawn from prior analysis of the Multicentre Study of Self-Harm in England, while estimates of the effectiveness of psychosocial assessment on risk of self-harm, quality of life impacts and other costs were supplemented by a literature review. Incremental cost-effectiveness ratios (ICERs) were estimated in terms of cost per Quality Adjusted Life Year (QALY) gained and parameter uncertainty was addressed in univariate and probabilistic sensitivity analyses. Costs were reported in 2020 UK Pounds (GBP) from the healthcare and societal perspective (that included productivity loss) and a discount rate of 3.5% was applied to future costs and QALYs. Results. The cost per QALY gained from psychosocial assessment was GBP 10,962 (95% uncertainty interval (UI) GBP 15,538 - GBP 9,219) from the NHS perspective, and GBP 9,980 (95% UI GBP 14,538, GBP 6,938) from the societal perspective. Baseline results were generally robust to changes in model assumptions; the relative risk of self-harm after psychosocial assessment would have to be 0.73 or lower for the ICER to be below GBP 20,000. The cost-effectiveness acceptability curve showed that the probability of the ICER to be below a GBP 20,000 threshold was 78%, rising to 91% with a GBP 30,000 threshold. Conclusions Psychosocial assessment as implemented in the English NHS is likely to be cost-effective. This evidence could support adherence to NICE guidelines. However, further evidence is still needed about the precise impact of psychosocial assessment on self-harm repetition and costs to individuals affected by self-harm and their families beyond immediate hospital stay.

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Risk assessment scales to predict risk of hospital treated repeat self-harm: A cost-effectiveness modelling analysis

Cited by 11 publications

References 36 publications

Development and Validation of the Suicide Behaviours Questionnaire – Autism Spectrum Conditions in Autistic, Possibly Autistic and Non-Autistic Adults.

Development and Validation of the Suicide Behaviours Questionnaire – Autism Spectrum Conditions in Autistic, Possibly Autistic and Non-Autistic Adults.

Role of the GP in the management of patients with self-harm behaviour: a systematic review

Cost-effectiveness of psychosocial assessment for individuals who present to hospital following self-harm in England: a model-based retrospective analysis

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