Why Do Self-Harm Prediction Models Struggle to Generalise? Lexical and Semantic Variations in Emergency Department Triage Notes

Self-harm presentations to emergency departments (EDs) are strongly associated with higher suicide risk. NLP models have shown robust performance in detecting self-harm from triage notes within single hospitals, yet performance often declines across institutions. To examine potential causes, we compare ED triage notes from two hospitals by analyzing lexical characteristics, highly associated predictive features, and salient topics. Our results reveal variation in lexical expression and feature importance related to self-harm across hospitals, despite consistent core themes such as self-poisoning and self-injury. These documentation differences are associated with reduced cross-site performance. Our findings provide insight into how institutional variation affects the identification of self-harm in clinical text and highlight potential methods to improve model generalisability.

FigSIM: A Dataset for Fine-grained Suicide Severity and Figurative Language in Suicide Memes

Suicide memes are memes used to express suicide-related thoughts or comment on suicide-related issues. Suicide memes are increasingly common on social media, yet remain poorly understood and potentially harmful. There is an urgent need to better understand their characteristics and to develop appropriate content moderation strategies that limits users' exposure to potentially harmful content. Currently, the absence of annotated datasets of suicide memes remains a key barrier to developing and evaluating automated moderation approaches. In this paper, we introduce FigSIM, the first dataset designed for fine-grained analysis of suicide memes. The dataset consists of 1049 memes, each annotated for (1) fine-grained suicide severity levels, (2) figurative phenomena (e.g., metaphors), and (3) suicide-related content (e.g., suicide method depiction). We benchmark 16 unimodal and multimodal models across three tasks: figurative language, suicide severity, and suicide-related content detection. Overall, FigSIM demonstrates that suicide memes pose unique challenges for both modeling and content moderation. Analysis revealed biases, such as underprediction of higher suicide severity levels, especially for figurative memes. The dataset (including splits used for analyses) is publicly available. Content Warning: This paper contains suicide-related content that may be triggering.

Transferable Self-Harm Surveillance from Emergency Department Triage Notes Using an Evidence-Augmented Machine Learning Approach

Self-harm is a major public health concern, but current surveillance relying on hospital presentations is inadequate due to the low sensitivity of diagnostic codes. Emergency Department (ED) triage notes, recorded at the initial point of contact, provide a succinct summary of presentations and an opportunity to identify self-harm. We developed a three-stage approach, augmenting traditional machine learning with large language model-based screening and evidence extraction to detect self-harm in ED triage notes. We assessed model transferability across three Australian hospitals. Our approach showed AUPRCs of 0.887 +/- 0.016 and 0.884 +/- 0.012 during internal and external validation. Prospectively, it achieved AUPRC of 0.881 +/- 0.008 at the development site, and 0.879 +/- 0.012 and 0.816 +/- 0.015 at two external sites without site-specific retraining. A key advantage of the approach is that it enables identification of the primary self-harm method with an accuracy of 95%, supporting more granular surveillance beyond binary classification.