Suicide and Self-Harm Risk Assessment: A Systematic Review of Prospective Research

Area of Science:

• Psychiatry
• Public Health

Background:

• Suicide and self-harm are significant public health concerns, yet often underreported.
• Effective prevention and management strategies rely on accurate risk assessment.
• Existing evidence on the predictive accuracy of risk assessment tools is contradictory.

Approach:

• A systematic review of prospective research from electronic and gray literature databases was conducted.
• Studies were independently screened and selected, with quality and evidence levels assessed.
• A narrative synthesis was performed due to heterogeneity, categorized by outcomes, clinician assessment, and healthcare utilization.

Key Points:

• The SAD PERSONS Scale showed some utility in predicting hospital admissions but not repeat behaviors.
• Clinician risk assessment yielded mixed results, with some studies favoring it and others finding it ineffective.
• No single tool, including clinician judgment, demonstrated sufficient evidence for predicting self-harm or suicidality.

Conclusions:

• There is insufficient evidence to endorse any specific risk assessment tool or clinician assessment for self-harm and suicidality.
• The focus should shift towards comprehensive patient safety discussions for at-risk individuals.
• Structured professional judgment is recognized as a widely accepted approach in risk assessment.