Risk assessment scales, categories and tools should not be used to predict suicide risk
Many risk assessment tools and scales categorise patients into high, medium or low risk to determine treatment options and predict suicide risk. However, the accuracy of many of these has been found to be poor. These scientific articles reflect the growing evidence that risk assessment tools and scales should not be used to predict suicide risk or to allocate treatment.
Combinations of risk factors did not accurately identify those at greatest risk of further self-harm and suicide. Risk scales should have little role in the management of people who have self-harmed.
- Accuracy of individual and combined risk-scale items in the prediction of repetition of self-harm: multicentre prospective cohort study (BJPsych Open, 2021)
Risk scales did not accurately predict repeat self-harm and suicide. Findings support existing clinical guidance not to use risk classification scales alone to determine treatment or predict future risk.
- Accuracy of risk scales for predicting repeat self-harm and suicide: a multicentre, population-level cohort study using routine clinical data (BMC Psychiatry, 2018)
Risk scales should not be used to determine patient management following self-harm or to predict self-harm. Most risk scales following self-harm performed no better than clinician or patient ratings of risk. Some performed considerably worse.
- Predictive accuracy of risk scales following self-harm: multicentre, prospective cohort study (The British Journal of Psychiatry, 2017)
Risk assessment scales should not be used to predict future suicidal behaviour or allocate treatment due to their limited accuracy.
- Predicting suicidal behaviours using clinical instruments: Systematic review and meta-analysis of positive predictive values for risk scales (British Journal of Psychiatry, 2017)
The limited sensitivity of risk assessment scales means that some low-risk patients might be deprived of treatment options, and will go on to die by suicide.
Use of risk assessment scales or an over-reliance on identification of risk factors in clinical practice may provide false reassurance and is therefore potentially dangerous. Comprehensive assessments of adjustable risk factors and needs of each individual should be central to the management of people who have self-harmed.
- Predicting suicide following self-harm: systematic review of risk factors and risk scales (British Journal of Psychiatry, 2016)
This review showed that no risk scales following self-harm perform sufficiently well in terms of diagnostic accuracy to be recommended for routine clinical use. Risk scales should only be used in addition to assessment.
- Which are the most useful scales for predicting repeat self-harm? A systematic review evaluating risk scales using measures of diagnostic accuracy (BMJ Open, 2016)
This study examined the association between the use of a risk scale and measures of service quality and repeat self-harm within 6 months. There was little consensus over the best instruments for risk assessment following self-harm.
- Scales for predicting risk following self-harm: An observational study in 32 hospitals in England (BMJ Open, 2014)
Suicide risk assessment in an individual is not precise but may be life-saving when undertaken alongside clinical action.
- Assessing risk of suicide or self-harm in adults (BMJ, 2013)
As a large number of people who present to hospital following self-harm are assessed as being at low or moderate risk of repeat self-harm, restricting interventions only to people assessed as being at high risk would prevent fewer than one-fifth of repeat self-harm incidents.
Standard approaches to suicide prevention concentrate on the rigorous assessment and management of suicidal risk. A more effective approach to reduce suicide rates is to offer a basic intervention to all those who have harmed themselves, and using clinical skills and risk assessment to identify high-risk individuals who might benefit from more intensive treatment.
- Against a high-risk strategy in the prevention of suicide (Psychiatric Bulletin, 1998)