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Screening for Suicide Risk

June 3, 2014

Screening for Suicide Risk

  1. Jamaluddin Moloo, MD, MPH

The U.S. Preventive Services Task Force again concludes that evidence is insufficient to make a recommendation for or against screening.

  1. Jamaluddin Moloo, MD, MPH

Sponsoring Organization: U.S. Preventive Services Task Force (USPSTF)

Target Audience: Primary care clinicians

Background and Objective

In 2010, suicide was the 10th leading cause of death in the U.S. and among the top five leading causes of death in adolescents and younger adults (age range, 10–54). In its 2004 review, the USPSTF concluded that evidence was insufficient to make a recommendation on screening for suicide risk (Ann Intern Med 2004; 140:820). The USPSTF now has updated its analysis.

Key Points

  • Nearly 40% of adults visited their primary care clinician within 1 month of committing suicide.

  • Risk factors: The highest suicide rates are among young Native American and Alaskan natives (age range, 19–24) and older non-Hispanic whites (age, >75). Post-traumatic stress disorder (PTSD), substance abuse, and depression raise risk. Important social factors include adverse childhood events; unemployment; social isolation; family history of suicide; and discrimination associated with being gay, lesbian, bisexual, or transgender. Traumatic brain injury or PTSD associated with military service and recent release from military service also are associated with higher risk.

  • Screening tests: The sensitivity and specificity of various instruments to identify suicide risk varied widely.

  • Interventions: In people who are at risk for suicide, cognitive behavioral therapy and group therapy often are effective.

No direct evidence indicated that screening improved health outcomes, and evidence about potential harms was insufficient. The USPSTF concluded that current evidence is insufficient to evaluate the benefits and harms of screening for suicide risk among adolescents and adults in primary care settings (Grade: I [no recommendation]).

Comment

This update on screening and intervening for suicide risk shows that little progress has been made, leaving us with another “I statement.”

  • Disclosures for Jamaluddin Moloo, MD, MPH at time of publication Grant / Research support Colorado Health Foundation

Citation(s):

Reader Comments (2)

John Ramar, Esq. Other, Other, Medical Malpractice Defense

Having defended countless psychiatrists in adult and adolescent suicide cases, it is only the Plaintiff (patient's) pyschiatric expert who believes (and testifies) that the sensitivity of screening tests for suicidality is valuable and would have predicted and prevented the patient's demise.

CHRISTIANE CHADDA Other, Other, retired RN,BSc,MA

At the age of 19 I attempted suicide in London. Having survived
severe PTSD partially related to a traumatized childhood in WW II,
then having left my family at age 18 for another country that did not want me (and made that clear), I simply saw no other way.
That was the end of my attempt to make my way as a nursing student. The criterion here is absolute lack of family and other support. Early life was so traumatic that it was extremely hard to make it through life and to achieve what I did. And,at the age of 74 ,the past once again became unbearable. 6 years of psychotherapy later I can say very confidently: There can never be a SCREENING TEST FOR SUICIDE. This innermost horror of taking the ultimate step is a hidden secret. If there were any inclination, it would likely be 'attention- getting" , especially in the very young.

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