Improving Suicide Risk Screening to Identify the Highest Risk Patients: Results From the PRImary Care Screening...

Area of Science:

• Psychiatry
• Clinical Psychology
• Public Health

Background:

• The Patient Health Questionnaire-9 (PHQ-9) suicide risk item has low positive predictive value, leading to potential over-treatment.
• Accurate identification of suicide risk is crucial for effective mental healthcare and resource management.

Purpose of the Study:

• To enhance the accuracy of suicide risk screening in primary care.
• To identify patients at high risk of suicidal behavior more effectively than the PHQ-9 alone.

Main Methods:

• Recruited 2,744 patients from US Department of Defense primary care clinics.
• Administered the PHQ-9 and Suicide Cognitions Scale (SCS) during routine visits.
• Assessed suicidal behaviors using the Self-Injurious Thoughts and Behaviors Interview.

Main Results:

• 0.5% of patients screened positive for suicidal behavior within 30 days; 1.0% within 90 days.
• Multiple SCS items distinguished patients with subsequent suicidal behavior.
• Augmenting the PHQ-9 with SCS items improved identification of high-risk patients without reducing sensitivity.

Conclusions:

• The Suicide Cognitions Scale (SCS) enhances the efficiency of suicide risk screening.
• SCS items help identify primary care patients most likely to exhibit suicidal behavior within 30 days of screening positive on the PHQ-9.