title: A systematic review of psychometric assessment of self-harm risk in the emergency department.
abstract: BACKGROUND
  Assessment of self harm risk is both a common and difficult task in emergency room settings. Psychometric measures have been developed to help with this assessment but it is uncertain how well these measures perform and which are clinically useful for assessment in this setting.
  
  
  METHODS
  Two reviewers independently assessed studies for relevance, inclusion, and study quality. Included studies classified mostly adult patients at risk for self-harm treated in an ED. The outcome variables selected were recurrence of self-harm/suicidal ideation or hospitalization. Only cohort study designs with follow-up were eligible.
  
  
  RESULTS
  From 556 potentially relevant abstracts, 12 studies were identified for inclusion in the review. Overall, the risk of bias was considered moderate to low in this review. Of the included studies reporting future self harm as an outcome measure, only the scales that are part of the Manchester self harm project, the Implicit Associations Test and the Violence and Suicide Assessment Form were found to successfully predict self harm. The four studies that assessed admission as an outcome utilized eight different actuarial methods. Of the scales assessed, six were found to be significant predictors of admission.
  
  
  CONCLUSIONS
  It was not possible to perform a meta-analysis with the studies detected and it is uncertain whether publication bias or selection bias within the reviewed studies affected the results.
  
  
  CONCLUSIONS
  Overall, while many methods used in the ED to assess suicidal and parasuicidal patients have strong psychometric properties, there is little clinical evidence supporting their use.
authors.affiliation: Department of Public Health Sciences, School of Public Health, University of Alberta, Edmonton, Canada.
authors.forename: Jason R
authors.initials: JR
authors.lastname: Randall
authors.forename: Ian
authors.initials: I
authors.lastname: Colman
authors.forename: Brian H
authors.initials: BH
authors.lastname: Rowe
mesh_terms: D000328:Adult; D006801:Humans; D015982:Bias; D015331:Cohort Studies; D004636:Emergency Service, Hospital; D005500:Follow-Up Studies; D006760:Hospitalization; D017063:Outcome Assessment, Health Care; D011594:Psychometrics / Q000295:instrumentation; D017594:Publication Bias; D012008:Recurrence; D012107:Research Design; D018570:Risk Assessment / Q000379:methods; D016728:Self-Injurious Behavior / Q000145:classification / Q000175:diagnosis; D013405:Suicide / Q000706:statistics & numerical data