Abstract
BackgroundBiological factors have been associated with deliberate self-harm (DSH) but have not been integrated with clinical factors in routine risk assessments.This study aimed to examine the incremental validity of lipid levels and platelet serotonin when combined with psychosocial factors in risk assessments for repeated admissions due to DSH.MethodsIn this prospective observational study of 196 acutely admitted patients, results of blood tests performed upon admission and the MINI Suicidal Scale and psychosocial DSH risk factor assessments performed at discharge were compared with the incidence of DSH recorded during the first 3 and 12 months after discharge.ResultsHigh triglyceride levels were found to be a significant marker for patients admitted 3 or more times due to DSH (repeated DSH, DSH-R) when tested against other significant risk factors. When all (9) significant univariate factors associated with 12-month post-discharge DSH-R were analyzed in a multivariate logistic regression, the MINI Suicidal Scale (p = 0.043), a lack of insight (p = 0.040), and triglyceride level (p = 0.020) remained significant. The estimated 12-month area under the curve of the receiver operator characteristic (ROC-AUC) for DSH-R was 0.74 for triglycerides, 0.81 for the MINI, 0.89 for the MINI + psychosocial factors, and 0.91 for the MINI + psychosocial factors + triglycerides. The applied multifaceted approach also significantly discriminated between 12-month post-discharge DSH-R patients and other DSH patients, and a lack of insight (p = 0.047) and triglycerides (p = 0.046) remained significant for DSH-R patients in a multivariate analysis in which other DSH patients served as the reference group (rather than non-DSH patients).ConclusionThe triglyceride values provided incremental validity to the MINI Suicidal Scale and psychosocial risk factors in the assessment of the risk of repeated DSH. Therefore, a bio-psychosocial approach appears promising, but further research is necessary to refine and validate this method.
Highlights
Biological factors have been associated with deliberate self-harm (DSH) but have not been integrated with clinical factors in routine risk assessments
A recent multicenter study showed that clinical decision rules based on 5 variables could be used to enhance risk assessment of repeated deliberate self-harm (DSH-R) in patients admitted to emergency units [7]
In a prospective study examining different screening methods for deliberate self-harm risk during the first year after discharge from an emergency psychiatric ward, we found that (i) high triglyceride (TG) levels [19], (ii) the The MINI international neuropsychiatric interview (MINI) Suicidal Scale [3], and (iii) patients’ own estimates of future risk (Self-report Risk Scale) [20] were significant predictors of self-harming behavior following discharge from an emergency psychiatric ward
Summary
Biological factors have been associated with deliberate self-harm (DSH) but have not been integrated with clinical factors in routine risk assessments. Acute settings are characterized by time pressure and high patient turnover. Screening instruments, such as the MINI Suicidal Scale, have been shown to help identify patients at risk for self-harm [3], and a 27-item scale based on 154 items from a collection of suicidal assessment instruments showed promise for the development of a new scale evaluating suicidal risk in settings in which time is limited [4]. A recent multicenter study showed that clinical decision rules based on 5 variables (gender, current psychiatric treatment, previous self-harm, antidepressant treatment, and/or self-poisoning with benzodiazepines) could be used to enhance risk assessment of repeated deliberate self-harm (DSH-R) in patients admitted to emergency units [7]
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