Risk Factors for Repetition of Self-Harm: A Systematic Review of Prospective Hospital-Based Studies

Abstract

BackgroundSelf-harm entails high costs to individuals and society in terms of suicide risk, morbidity and healthcare expenditure. Repetition of self-harm confers yet higher risk of suicide and risk assessment of self-harm patients forms a key component of the health care management of self-harm patients. To date, there has been no systematic review published which synthesises the extensive evidence on risk factors for repetition.ObjectiveThis review is intended to identify risk factors for prospective repetition of self-harm after an index self-harm presentation, irrespective of suicidal intent.Data sourcesPubMed, PsychInfo and Scirus were used to search for relevant publications. We included cohort studies which examining factors associated with prospective repetition among those presenting with self-harm to emergency departments. Journal articles, abstracts, letters and theses in any language published up to June 2012 were considered. Studies were quality-assessed and synthesised in narrative form.ResultsA total of 129 studies, including 329,001 participants, met our inclusion criteria. Some factors were studied extensively and were found to have a consistent association with repetition. These included previous self-harm, personality disorder, hopelessness, history of psychiatric treatment, schizophrenia, alcohol abuse/dependence, drug abuse/dependence, and living alone. However, the sensitivity values of these measures varied greatly across studies. Psychological risk factors and protective factors have been relatively under-researched but show emerging associations with repetition. Composite risk scales tended to have high sensitivity but poor specificity.ConclusionsMany risk factors for repetition of self-harm match risk factors for initiation of self-harm, but the most consistent evidence for increased risk of repetition comes from long-standing psychosocial vulnerabilities, rather than characteristics of an index episode. The current review will enhance prediction of self-harm and assist in the efficient allocation of intervention resources.

Are neurocognitive factors associated with repetition of self-harm? A systematic review

“…Previous systematic reviews on repetition of self-harm have: (i) focussed only on certain forms of self-harm (Fliege et al, 2009); (ii) included little or no data on potential neurocognitive factors (Mendez-Bustos et al, 2013); (iii) focussed only on psychometric tools in hospital (Randall et al, 2011); (iv) focussed only on hospital admissions (Larkin et al, 2014). As far as we are aware, there is no previous systematic review of the major neurocognitive factors and repetition of self-harm, inclusive of all forms of self-harm and all settings.…”

“…However, it was not able to be included because it classified "recent self-harm" as occurring within the last year, which was an exclusion criteria for the current review. Larkin and colleagues' systematic review of prospective hospital studies found that a few studies assessed autobiographical memory and overall there was a small association with repetition of self-harm (Larkin et al, 2014). There may also be other important aspects of memory: Martinez-Aran determined that impairments of verbal memory (on the California Verbal Learning Test) were correlated with the number of suicide attempts in secondary analyses (Martinez-Aran et al, 2004).…”

The exacerbating influence of hopelessness on other known risk factors for repeat self-harm and suicide

“…In a recent international review of case-control and cohort studies, hopelessness was found to be associated with a greater than twofold increase in risk of suicide amongst people with depression (Hawton et al, 2013). However, prospective, hospital-based studies of self-harm have tended to examine risk factors in isolation, overlooking their cumulative effect (Larkin et al, 2014). Their inclusion could enhance understanding of some existing known risk factors (Kessler et al, 1999;Larkin et al, 2014).…”

“…However, prospective, hospital-based studies of self-harm have tended to examine risk factors in isolation, overlooking their cumulative effect (Larkin et al, 2014). Their inclusion could enhance understanding of some existing known risk factors (Kessler et al, 1999;Larkin et al, 2014).…”

The involvement of alcohol in hospital-treated self-harm and associated factors: findings from two national registries

“…[1,2] A recent study found that premature, alcohol-related deaths were nine times more likely among those who engage in self-harm compared to the general population. [3] Furthermore, acute alcohol consumption is linked to impulsive suicidal behaviours.…”