Predicting repeated self-harm or suicide in adolescents and young adults using risk assessment scales/tools: a systematic review protocol

Background: Self-harm and suicide have been identified as serious public health problems in children, adolescents, and young people across the world. Suicide is a major cause of mortality in this population and is commonly preceded by self-harm. Both suicide and self-harm are difficult to predict, and several risk scales and tools are in use for this purpose. Currently, there is only a small amount of evidence available regarding their predictive ability in clinical practice, and no consensus as to which is the most suitable for particular populations or settings. The aim of this review is to evaluate the ability of risk scales to predict future episodes of suicide or self-harm in adolescents and young adults presenting to clinical services with attempted suicide or an episode of self-harm. Methods: A comprehensive search of electronic databases (MEDLINE, EMBASE, CINAHL, and PsycINFO) from inception will be conducted to identify studies that look at the ability of risk scales to predict suicide or future episodes of self-harm in adolescents and young adults presenting to clinical services with attempted suicide or an episode of self-harm. Two authors will independently carry out key methodological steps such as study screening and selection and data extraction. Quality assessment will be carried out using a checklist developed from the QUIPS and QUADAS-2 tools. Data will be grouped by tool and a narrative synthesis undertaken. For each tool, meta-analysis will be undertaken for ability to predict suicide or repeat self-harm where clinical and methodological homogeneity exists. Discussion: This systematic review will be the first to explore the use of assessment scales/tools in an adolescent population and will help to inform current practice regarding scales/tools with higher predictive ability. There is currently no evidence specifically for this population and a clear need with a high prevalence of self-harm and suicide in adolescents. Additionally, this review will help guide future research into suicide and self-harm prediction and prevention.