The PRImary care Screening Methods (PRISM) study: Rationale and design considerations.

Area of Science:

• Public Health
• Clinical Psychology
• Military Medicine

Background:

• Primary care settings are frequently accessed by individuals prior to suicidal behavior.
• Nearly half of suicide decedents have a primary care visit within one month of death.
• There is a lack of data on the effectiveness of suicide risk screening in primary care.

Purpose of the Study:

• To develop and assess an alert algorithm for military primary care providers to identify high-risk patients.
• To enhance the identification of high-risk patients who deny suicidal ideation.
• To identify patient subgroups often missed by current suicide screening methods.

Main Methods:

• The PRImary care Screening Methods (PRISM) study enrolled 2690 patients across six U.S. military primary care clinics.
• Participants completed self-report scales during routine clinic visits.
• Follow-up interviews were conducted at 1, 6, and 12 months, with suicide attempt as the primary outcome.

Main Results:

• The PRISM study is the first to prospectively evaluate multiple suicide risk screening methods in real-world military primary care.
• The study considered ethical and design factors to protect participants, particularly those at risk of suicide.
• The research aims to minimize the confounding effects of risk management protocols on screening efficacy.

Conclusions:

• The PRISM study provides a novel approach to suicide risk screening in military primary care.
• The findings will inform the development of more effective suicide prevention strategies.
• Protecting vulnerable populations while ensuring research integrity is paramount.