What are the recommendations for suicide risk screening?
Medically reviewed by Louis-Antoine Mullie, MD.
Answer
The recommendations for suicide risk screening vary based on the population and context:
General population
- The DoD/VA 2024 guidelines state that there is insufficient evidence to recommend for or against suicide risk screening programs to reduce the risk of suicide or suicide attempts in the general population
- The USPSTF 2023 guidelines also conclude that the current evidence is insufficient to assess the balance of benefits and harms of screening for suicide risk in adults, including pregnant and postpartum individuals and older adults
Specific populations
- The APA 2010 guidelines recommend a careful and ongoing evaluation of suicide risk in all patients with major depressive disorder
- The AAFP 2015 guidelines recommend assessing the risk of suicide in patients with an eating disorder
- The APA 2020 guidelines recommend assessing the risk of suicide and aggressive behaviors in the initial assessment of patients with a possible psychotic disorder
- The AAN 2019 guidelines recommend assessing for suicidal thoughts and suicide attempts in patients with Tourette's syndrome
- The DoD/VA 2022 guidelines recommend assessing the risk of suicide and self-directed violence when initiating, continuing, changing, or discontinuing long-term opioid therapy
Choice of screening tool
- The DoD/VA 2024 guidelines suggest using validated tools such as the Columbia Suicide Severity Rating Scale Screener, Suicide Cognition Scale-Revised, and PHQ-9 in the general population to identify patients at risk for suicide-related behavior
- For at-risk populations, the Beck Suicide Intent Scale/Beck Scale for Suicidal Ideation and Columbia Suicide Severity Rating Scale Screener are recommended
Risk assessment
- The DoD/VA 2024 guidelines suggest considering factors within domains such as self-directed violence, thoughts, and behaviors, current psychiatric conditions, psychiatric symptoms, social determinants of health, availability of lethal means, physical health conditions, and demographic characteristics when assessing suicide risk
- The ACEP 2017 guidelines recommend not using currently available risk-assessment tools in isolation to identify low-risk patients safe for discharge for patients presenting to the emergency department with suicidal ideation. An appropriate psychiatric assessment and good clinical judgment, taking patient, family, and community factors into account, is the best approach to determine risk
In conclusion, the recommendations for suicide risk screening are context-dependent and involve a combination of validated tools and comprehensive risk assessment. The evidence for universal screening in the general population is currently insufficient, and the emphasis is on specific high-risk populations and clinical judgment.