就诊于医疗保健服务的个体再次自我伤害的风险：临床风险评估模型（OxSET）的制定与验证。

Risk of repeat self-harm among individuals presenting to healthcare services: development and validation of a clinical risk assessment model (OxSET).

机构信息

Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK

Oxford Health NHS Foundation Trust, Oxford, UK.

出版信息

BMJ Ment Health. 2024 Oct 15;27(1):e301180. doi: 10.1136/bmjment-2024-301180.

DOI:10.1136/bmjment-2024-301180

PMID:39414315

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11481133/

Abstract

BACKGROUND

A self-harm episode is a major risk factor for repeat self-harm. Existing tools to assess and predict repeat self-harm have major methodological limitations, and few are externally validated.

OBJECTIVE

To develop and validate a risk assessment model of repeat self-harm up to 6 months after an episode of non-fatal self-harm that resulted in an emergency visit to hospital or specialised care.

METHODS

Using Swedish national registers, we identified 53 172 people aged≥10 years who self-harmed during 2008-2012. We allocated 37 523 individuals to development (2820 or 7.5% repeat self-harm incidents within 6 months) and 15 649 to geographic validation (1373 repeat episodes) samples, based on region of residence. In a temporal validation of people who self-harmed during 2018-2019, we identified 25 036 individuals (2886 repeat episodes). We fitted a multivariable accelerated failure time model to predict risk of repeat self-harm.

FINDINGS

In the external validations (n=40 685), rates of repeat self-harm were 8.8%-11.5% over 6 months. The final model retained 17 factors. Calibration and discrimination were similar in both validation samples, with observed-to-expected ratio=1.15 (95% CI=1.09 to 1.21) and c-statistic=0.72 (95% CI=0.70 to 0.73) in the geographical validation. At 6 months and a 10% risk cut-off, sensitivity was 51.5% (95% CI=48.8% to 54.2%) and specificity was 80.7% (95% CI=80.1% to 81.4%) in geographic validation; corresponding values were 56.9% (95% CI=55.1% to 58.7%) and 76.0% (95% CI=75.5% to 76.6%) in temporal validation. Discrimination was slightly worse at the 1-month prediction horizon (c-statistics of 0.66-0.68).

CONCLUSIONS

Using mostly routinely collected data, simple risk assessment models and tools can provide acceptable levels of accuracy for repeat of self-harm.

CLINICAL IMPLICATIONS

This risk model (OXford SElf-harm repeat tool) may assist clinical decision-making.

摘要

背景

自残发作是重复自残的主要危险因素。现有的评估和预测重复自残的工具存在重大方法学局限性，且很少经过外部验证。

目的

建立并验证一种非致命性自伤发作后 6 个月内重复自伤的风险评估模型，该自伤发作导致急诊就诊或专科治疗。

方法

利用瑞典全国登记处，我们确定了 2008-2012 年期间年龄≥10 岁的 53172 名自残者。我们根据居住地将 37523 名个体分配到发展（6 个月内发生 2820 次或 7.5%重复自伤事件）和 15649 名个体分配到地理验证（1373 次重复事件）样本中。在对 2018-2019 年期间自残者的时间验证中，我们确定了 25036 名个体（2886 次重复事件）。我们拟合了多变量加速失效时间模型来预测重复自伤的风险。

结果

在外部验证中（n=40685），6 个月内重复自伤的发生率为 8.8%-11.5%。最终模型保留了 17 个因素。在两个验证样本中，校准和区分度相似，观察到的与预期的比值为 1.15（95%CI=1.09 至 1.21），c 统计量为 0.72（95%CI=0.70 至 0.73）在地理验证中。在 6 个月和 10%风险截止值时，地理验证中的敏感性为 51.5%（95%CI=48.8%至 54.2%），特异性为 80.7%（95%CI=80.1%至 81.4%）；在时间验证中，相应的值分别为 56.9%（95%CI=55.1%至 58.7%）和 76.0%（95%CI=75.5%至 76.6%）。在 1 个月的预测期，区分度略差（c 统计量为 0.66-0.68）。