Suicide Prevention Among People of Different Races and Ethnicities in Large Health Systems: Implications for Practice

This study examined receipt of three components (screening, risk assessment, and intervention) of the national Zero Suicide model among patients of various races-ethnicities who were treated in six large health systems.

The data included outpatient psychiatry and addiction medicine visits (N=4,682,918) during 2019 for patients age 13 and older. Documentation in the electronic health record of administration of the nine-item Patient Health Questionnaire, the Columbia-Suicide Severity Rating Scale, and lethal means counseling and provision of crisis resources (with or without a full Stanley-Brown Safety Plan) were used to define having received suicide screening, risk assessment, and intervention, respectively.

After adjustment for age, sex, and health system, analyses indicated that Black patients were 12%-20% less likely (odds ratio [OR] range 1.12-1.20), and Asian patients were 5%-15% more likely (OR range 1.05-1.15), to be screened for suicidal ideation compared with patients of other races-ethnicities. Compared with White patients, patients of other races-ethnicities were found to be more likely (OR range 1.08-1.24) to receive risk assessment, and Asian and Black patients were found to be 17% (95% CI=1.02-1.35) and 15% (95% CI=1.01-1.32) more likely, respectively, to receive an evidence-based intervention for suicide prevention. American Indian/Alaska Native (AI/AN) patients had the lowest unadjusted rates of receiving an intervention (65.8%).

The adjusted analyses suggested that more focus is needed on population-based screening for suicidal ideation and to improve delivery of evidence-based interventions for suicide prevention among White patients. The descriptive findings suggest that more research is needed to improve intervention delivery to AI/AN patients at risk of suicide.