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RESEARCH: David Gunnell, Keith Hawton, Davidson Ho, Jonathan Evans, Susan O’Connor, John Potokar, Jenny Donovan, and Nav Kapur Hospital admissions for self harm after discharge from psychiatric inpatient care: cohort study BMJ 2008; 337: a2278 [Abstract] [Full text]

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Strong Need for Risk Assessment Tools

Rizaldy Pinzon   (5 December 2008)

Strong Need for Risk Assessment Tools 5 December 2008
Rizaldy Pinzon, Neurologist Bethesda Hospital, Yogyakarta Indonesia 55224 Send response to journal: Re: Strong Need for Risk Assessment Tools	The article from Dr. Gunnell is very interesting. The rate of hospital readmission is high (6% in 12 months). This rate is lower than the previous systematic reviews from Owens et. al. that showed non-fatal repetition rates are around 15% in 1 year. The most important question is "how can we predict patients of highest risk for readmission?" Previous study from Kapur et.al. showed that risk assessments may have influenced subsequent management. Restricting intervention to people identified as at high risk, even assuming a completely effective intervention, would prevent fewer than one fifth of repeat episodes. The problem is some of the tools have low predictive value. This study showed that previous clinical diagnosis is the strongest predictor.It is consistent with the previous finding that showed the patient was considered to be at moderate or high risk of repeat self harm or suicide if any 1 of the 4 components of the Manchester Self Harm Rule was present: (1) history of self harm, (2) previous psychiatric treatment, (3) current psychiatric treatment, or (4) benzodiazepine use in this attempt (Cooper et.al, 2006). It can be assumed that clinicians and hospital staffs should be more aware for the possibility of readmission in patients with history of self harm. References Kapur N, Rodway C, Kelly J, Guthrie E, Jones K, Predicting the risk of repetition after self harm: cohort study, BMJ 2005;330:394-395 Owens D, Horrocks J, House A, Fatal and non-fatal repetition of self- harm: Systematic review, The British Journal of Psychiatry, 2002 181: 193- 199 Cooper J, Kapur N, Dunning J, et al. A clinical tool for assessing risk after self-harm. Ann Emerg Med 2006;48:459–66 Competing interests: None declared