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

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  • Celine Larkin
  • Zelda Di Blasi
  • Ella Arensman

Abstract

Background: Self-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. Objective: This review is intended to identify risk factors for prospective repetition of self-harm after an index self-harm presentation, irrespective of suicidal intent. Data sources: PubMed, 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. Results: A 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. Conclusions: Many 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.

Suggested Citation

  • Celine Larkin & Zelda Di Blasi & Ella Arensman, 2014. "Risk Factors for Repetition of Self-Harm: A Systematic Review of Prospective Hospital-Based Studies," PLOS ONE, Public Library of Science, vol. 9(1), pages 1-13, January.
    • Handle: RePEc:plo:pone00:0084282
    DOI: 10.1371/journal.pone.0084282
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    References listed on IDEAS

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    2. Erik von Elm & Douglas G Altman & Matthias Egger & Stuart J Pocock & Peter C Gøtzsche & Jan P Vandenbroucke & for the STROBE Initiative, 2007. "The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for Reporting Observational Studies," PLOS Medicine, Public Library of Science, vol. 4(10), pages 1-5, October.
    3. Mayo, J.A., 1974. "Psychopharmacological roulette: a follow-up study of patients hospitalized for drug overdose," American Journal of Public Health, American Public Health Association, vol. 64(6), pages 616-617.
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