title: The Repeated Episodes of Self-Harm (RESH) score: A tool for predicting risk of future episodes of self-harm by hospital patients.
abstract: BACKGROUND
  Repetition of hospital-treated deliberate self-harm is common. Several recent studies have used emergency department data to develop clinical tools to assess risk of self-harm or suicide. Longitudinal, linked inpatient data is an alternative source of information.
  
  
  METHODS
  We identified all individuals admitted to hospital for deliberate self-harm in two Australian states (~350 hospitals). The outcome of interest was a repeated episode of self-harm (non-fatal or fatal) within 6 months. Logistic regression was used to identify a set of predictors of repetition. A risk calculator (RESH: Repeated Episodes of Self-Harm) was derived directly from model coefficients.
  
  
  RESULTS
  There were 84,659 episodes of self-harm during the study period. Four variables - number of prior episodes, time between episodes, prior psychiatric diagnoses and recent psychiatric hospital stay - strongly predicted repetition. The RESH score showed good discrimination (AUC=0.75) and had high specificity. Patients with scores of 0-3 had 14% risk of repeat episodes, whereas patients with scores of 20-25 had over 80% risk. We identified five thresholds where the RESH score could be used for prioritising interventions.
  
  
  CONCLUSIONS
  The trade-off of a highly specific test is that the instrument has poor sensitivity. As a consequence, the RESH score cannot be used reliably for "ruling out" those who score below the thresholds.
  
  
  CONCLUSIONS
  The RESH score could be useful for prioritising patients to interventions to reduce readmission for deliberate self-harm. The five thresholds, representing the continuum from low to high risk, enable a stepped care model of overlapping or sequential interventions to be deployed to patients at risk of self-harm.
authors.affiliation: Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC 3010, Australia. Electronic address: m.spittal@unimelb.edu.au.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Spittal
authors.affiliation: Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC 3010, Australia.
authors.forename: Jane
authors.initials: J
authors.lastname: Pirkis
authors.affiliation: Department of Health Policy and Management, Harvard School of Public Health, MA, United States.
authors.forename: Matthew
authors.initials: M
authors.lastname: Miller
authors.affiliation: Centre for Translational Neuroscience and Mental Health (CTNMH), Faculty of Health and Medicine, University of Newcastle, NSW, Australia.
authors.forename: Gregory
authors.initials: G
authors.lastname: Carter
authors.affiliation: Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC 3010, Australia.
authors.forename: David M
authors.initials: DM
authors.lastname: Studdert
mesh_terms: D000328:Adult; D001315:Australia; D005260:Female; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D018570:Risk Assessment; D016728:Self-Injurious Behavior / Q000523:psychology*; D012680:Sensitivity and Specificity
keywords: Deliberate self-harm; Epidemiology; Inpatient treatment; Risk assessment; Suicide