Accuracy of clinician predictions of future self-harm: a systematic review and meta-analysis of predictive studies

Assessment of a patient after hospital-treated self-harm or psychiatric hospitalisation often includes a “risk assessment”, resulting in a classification of high risk versus low risk for a future episode of self-harm. Through systematic review and a series of meta-analyses looking at unassisted clinician risk classification (8 studies; n= 22,499), we found pooled estimates for sensitivity 0.31 (95% CI: 0.18-0.50), specificity 0.85 (0.75-0.92), Positive Predictive Value (PPV) 0.22 (0.21-0.23) and Negative Predictive Value (NPV) 0.89 (0.86-0.92). Clinician classification was too inaccurate to be clinically useful. After-care should therefore be allocated on the basis of a needs rather than risk assessment.