title: Emergency department assessment of self-harm risk using psychometric questionnaires.
abstract: OBJECTIVE
  To examine several potential predictive screening tools for emergency department assessment of risk of self-harm.
  
  
  METHODS
  Adult patients presenting with self-harm or suicidal ideation were enrolled at 2 emergency departments at large teaching hospitals in Edmonton, Alberta. Patients completed a brief interview assessing demographics and psychiatric history and several questionnaires (the Beck Hopelessness Scale, the Barrett Impulsiveness Scale [BIS], and the Brief Symptom Inventory [BSI]) and drug and alcohol abuse screens (Drug Abuse Screening Test [DAST-10] and the Cut down, Annoyed, Guilt, Eye-opener [commonly referred to as CAGE] Questionnaire). At 3 months, patients were followed up via telephone and electronic health records to ascertain self-harm outcome. Questionnaires and their subscales were assessed using logistic regression. Receiver operating characteristic (ROC) analysis was performed on the results.
  
  
  RESULTS
  Among the 157 patients enrolled, 49% were women and 36% (of the total) were aged 18 to 29 years. Several of the subscales of the BSI and BIS as well as the DAST-10 were significant predictors of self-harm (P < 0.05). ROC analysis showed that none of the scales in isolation were very strong predictors. Hierarchical regression analysis that combined the significant scales with clinical risk factors that were significantly related to self-harm (that is, age, education level, history of self-harm, and whether they presented with self-harm or only suicidal ideation) indicated that the BIS and DAST-10 questionnaires each added significantly to the predictive ability of a model with these risk factors.
  
  
  CONCLUSIONS
  While many of the questionnaires and their related constructs are related to future self-harm, none of them are particularly strong and their diagnostic usefulness is limited.
authors.affiliation: Alberta Centre for Injury Control and Research, School of Public Health, University of Alberta, Edmonton, Alberta.
authors.forename: Jason R
authors.initials: JR
authors.lastname: Randall
authors.forename: Brian H
authors.initials: BH
authors.lastname: Rowe
authors.forename: Ian
authors.initials: I
authors.lastname: Colman
mesh_terms: D000293:Adolescent; D000328:Adult; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011594:Psychometrics / Q000295:instrumentation; D012372:ROC Curve; D018570:Risk Assessment; D016728:Self-Injurious Behavior / Q000175:diagnosis*; D012680:Sensitivity and Specificity; D059020:Suicidal Ideation; D011795:Surveys and Questionnaires