Screening for Suicide Risk in Adults: A Summary of the Evidence for the U.S. Preventive Services Task Force

University of North Carolina at Chapel Hill, Chapel Hill 27599, USA.
Annals of internal medicine (Impact Factor: 17.81). 06/2004; 140(10):822-35.
Source: PubMed


Suicide is the 11th leading cause of death and the seventh leading cause of years of potential life lost in the United States. Although suicide is of great public health significance, its clinical management is complicated.
The authors systematically reviewed the literature to determine whether screening for suicide risk in primary care settings decreases morbidity, mortality, or both.
MEDLINE (1966 to 17 October 2002), PsycINFO, Cochrane databases, hand-searched bibliographies, and experts.
For screening, only English-language studies performed in primary care settings were examined. For treatment, randomized, controlled trials and cohort studies were included if they were performed in any setting where suicide completions, suicide attempts, or suicidal ideation were reported.
A primary reviewer abstracted data on key variables of study sample, design, and outcomes; a second reviewer checked information accuracy against the original articles.
No study directly addressed whether screening for suicide in primary care reduces morbidity and mortality. The remainder of the review focused on the questions of reliable screening tests for suicide risk and the effectiveness of interventions to decrease depression, suicidal ideation, and suicide attempts or completion. One screening study provided limited evidence for the accuracy of suicide screening in a primary care setting. Intervention studies provided fair and mixed evidence that treating those at risk for suicide reduces the number of suicide attempts or completions. The evidence suggests mild to moderate improvement for interventions addressing intermediate outcomes such as suicidal ideation, decreased depressive severity, decreased hopelessness, or improved level of function.
Because of the complexity of studying the risk for suicide and the paucity of well-designed research studies, only limited evidence guides the primary care clinician's assessment and management of suicide risk.

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Available from: Bradley Gaynes, Jan 28, 2014
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    • "Es una pauta de reconocimiento de factores de riesgo suicida, breve y de fácil aplicación, por lo que es suficientemente sencilla y eficiente como para su eventual aplicación masiva (Lang, Uttaro, Caine, Carpinello y Felton, 2009; 2009b). El perfil de respuestas particular de cada consultante permite identificar tanto su riesgo como orientar el manejo clínico (Gaynes et al., 2004). Es así como puede constituir un aporte muy significativo a su tratamiento , ya que permite discriminar cuáles son los aspectos que aportan más al riesgo suicida actual en cada caso. "
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    ABSTRACT: En la mayoría de los países del mundo se ha observado un aumento preocupante del suicidio, ocupando Chile el segundo lugar en sus tasas de crecimiento. Queda en evidencia la gravedad de este problema y que la forma en que se está enfrentando no está dando los resultados esperados. El Ministerio de Salud (2011) en Chile se ha propuesto reducir las tasas de crecimiento del suicidio en adolescentes en un 15% para el año 2020. Sin embargo, actualmente no se están realizando las acciones preventivas y terapéuticas que permitan lograr estos resultados. Por lo tanto, es de crucial relevancia contar con instrumentos eficaces de evaluación del riesgo suicida. Se revisan algunos instrumentos, llegando a la conclusión que, dada la compleja multicausalidad del suicidio, cada uno de ellos se refiere a una o ciertas variables particulares y no considera otros factores relevantes. En este contexto, en el presente artículo se propone una pauta de cotejo (si/no) con indicadores específicos de riesgo suicida, de aplicación complementaria a una evaluación psiquiátrica o psicológica habitual. El objetivo de la pauta propuesta es optimizar la detección y evaluación de los consultantes en riesgo suicida, con aplicación tanto clínica como en investigación
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    • "Therefore, psychiatric professionals often are faced with the complex task of assessing the risk for suicide. Currently, there is no gold standard in suicide assessment , in terms of an instrument of first choice (Gaynes et al., 2004). In Dutch mental health care, recent guidelines state that all professionals (including psychiatrists, nurses, psychologists and psychotherapists) need to be able to explore the suicidal state. "
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    ABSTRACT: Background: Risk of suicide is notoriously difficult to assess, and no gold standard is available, in terms of an instrument of first choice. Many different instruments are in use, among which are some that are not properly psychometrically investigated. Aim: The aim of this study is to establish the psychometric properties of the Dutch version of the Nurses' Global Assessment of Suicide Risk scale (NGASR), and the feasibility of its use in assessing suicide risk. Therefore, our research questions are as follows: what is the reliability, validity, interpretability and feasibility of the NGASR? Methods: A psychometric study of acceptability, reliability and predictive validity among 252 patients making use of a concurrent instrument, the Suicide Intention Scale (SIS), concurrent assessment by a physician and 6-month follow-up. Results: Factor analysis identified five factors. Cronbach's alpha was .45. Intraclass correlation was .92 (95% confidence interval (CI) = .85-.95). Association between total NGASR and SIS was substantial and significant (B = 0.66, standard error of mean (SE) = 0.19, ß = .66, p = .003). NGASR total score had a significant and moderately strong association with judgement by a physician on 'suicidal thoughts' (odds ratio (OR) = 1.24, p = < .001) or 'suicidal thoughts or plans' (OR = 1.35, p = .001). No significant association of NGASR scores and 6-month follow-up of suicidality was found. Conclusions: Internal consistency of the NGASR and most of the subscales identified was low. Other indicators of reliability of the NGASR were sufficient, although predictive validity was poor. The NGASR did not outperform other instruments but is easy to use, and may contribute to identification of risk factors, as well as to a more integral assessment of suicide risk.
    International Journal of Social Psychiatry 07/2014; 61(3). DOI:10.1177/0020764014543311 · 1.15 Impact Factor
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    • "Screening for suicide risk in academic, primary care, and psychiatric settings has been implemented in an effort to prevent suicide. In 1996, the U.S. Preventative Task Force recommended suicide screening procedures in the primary care setting (U.S. Preventive Services Task Force, 1996), though a later evaluation of the program deemed the effectiveness of screening in this setting inconclusive (Gaynes et al., 2004). More recently, the "
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    ABSTRACT: The purpose of this study was to longitudinally examine specific characteristics of suicidal ideation in combination with histories of suicide attempts and non-suicidal self-injury (NSSI) to best evaluate risk for a future attempt among high-risk adolescents and emerging adults. Participants in this retrospective medical record review study were 473 (53% female; 69% Caucasian) consecutive patients, ages 15 to 24 years (M = 19.4 years) who presented for psychiatric emergency services during a 9-month period. These patients' medical records, including a clinician-administered Columbia-Suicide Severity Rating Scale, were coded at the index visit and at future visits occurring within the next 18 months. Logistic regression models were used to predict suicide attempts during this period. Socioeconomic status, suicidal ideation severity (i.e., intent, method), suicidal ideation intensity (i.e., frequency, controllability), a lifetime history of suicide attempt, and a lifetime history of NSSI were significant independent predictors of a future suicide attempt. Suicidal ideation added incremental validity to the prediction of future suicide attempts above and beyond the influence of a past suicide attempt, whereas a lifetime history of NSSI did not. Sex moderated the relationship between the duration of suicidal thoughts and future attempts (predictive for male patients but not female). Results suggest value in incorporating both past behaviors and current thoughts into suicide risk formulation. Furthermore, suicidal ideation duration warrants additional examination as a potential critical factor for screening assessments evaluating suicide risk among high-risk samples, particularly for male patients.
    Journal of Clinical Child & Adolescent Psychology 05/2014; 44(5):1-11. DOI:10.1080/15374416.2014.910789 · 1.92 Impact Factor
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