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A comparison between clinicians’ assessment and the Manchester Self-Harm Rule: a cohort study
  1. Jayne Cooper1,
  2. Navneet Kapur1,
  3. Kevin Mackway-Jones2
  1. 1
    Centre for Suicide Prevention, University of Manchester, Manchester, UK
  2. 2
    Emergency Medicine Research Group, Emergency Department, Manchester Royal Infirmary, Manchester, UK
  1. Dr Jayne Cooper, Centre for Suicide Prevention, University of Manchester, 7th Floor, Williamson Building, Oxford Road, Manchester M13 9PL, UK; jayne.cooper{at}


As identifying patients at risk of subsequent suicidal behaviour is a key goal of assessment, a cohort study of presentations to five emergency departments following episodes of self-harm was carried out. We compared the accuracy of the prediction of subsequent self-harm within 6 months between global clinical assessments and the Manchester Self-harm Rule. Sensitivity, specificity, and positive and negative predictive values with 95% confidence intervals (CI) were calculated. Global clinical assessments and the rule had a sensitivity of 85% (CI 83 to 87) versus 94% (CI 92% to 95%), specificity of 38% (CI 37% to 39%) versus 26% (CI 24% to 27%), a positive predictive value of 22% (CI 21% to 23%) versus 21% (CI 19% to 21%) and a negative predictive value of 92% (CI 91% to 93%) versus 96% (CI 94% to 96%). The accuracy of predicting short-term repetition of self-harm by clinicians could be improved by incorporating this simple rule into their assessment.

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  • Competing interests: None.

  • Funding: The project was funded by the Manchester Health Authority, South Manchester University Hospitals NHS Trust, Central Manchester Healthcare NHS Trust, North Manchester Healthcare NHS Trust (now Manchester Mental Health and Social Care Trust) and the Mental Health Services of Salford NHS Trust.

  • Ethical approval: The project and subsequent scientific papers based on anonymised aggregate data were ratified by the relevant local research ethics committees.