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Related Experiment Video

Updated: May 22, 2026

Implementation of a Real-Time Psychosis Risk Detection and Alerting System Based on Electronic Health Records using CogStack
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Risk Rulers for Rapid Screening and Detection of Suicide Risk in Acute Care.

Edwin D Boudreaux1,2,3, Hyein S Lee3, Celine Larkin1

  • 1Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA.

Suicide & Life-Threatening Behavior
|May 21, 2026
PubMed
Summary

Optimized suicide risk rulers provide a quick and easy way to screen for elevated and high suicide risk in emergency departments. These rulers showed strong performance, especially for identifying high-risk individuals.

Keywords:
emergency departmentrapid suicide screenerssuicidesuicide risksuicide screening

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Area of Science:

  • Emergency Medicine
  • Psychiatry
  • Public Health

Background:

  • Suicide risk screening in emergency departments (EDs) needs to be fast, intuitive, and accurate.
  • Optimizing 0-to-10 point suicide risk rulers is a potential solution.

Purpose of the Study:

  • To optimize suicide risk rulers for fast and accurate screening.
  • To compare the performance of optimized rulers against established screeners.

Main Methods:

  • 662 adult patients in two EDs completed five risk rulers, two best-practice screeners, and the Columbia Suicide Severity Rating Scale (CSSRS).
  • The CSSRS was used as the reference standard to calculate optimized cutoffs, performance metrics, and AUROCs.
  • Performance of rulers and screeners were compared for differentiating negligible vs. elevated risk and non-high vs. high risk.

Main Results:

  • Suicide risk rulers showed acceptable performance for elevated risk (AUROCs: 0.71-0.81) and strong performance for high risk (AUROCs: 0.91-0.95).
  • The sadness ruler best predicted elevated risk (AUROC: 0.81), and the suicidal ideation frequency ruler best predicted high risk (AUROC: 0.95).
  • Rulers outperformed a 3-item screener but not a 10-item screener.

Conclusions:

  • Suicide risk rulers serve as a fast, intuitive method for initial suicide risk detection in EDs.
  • Optimized rulers have acceptable operating characteristics for clinical use.
  • Findings can guide EDs in selecting the most suitable suicide risk screening approach.