Combination of risk scores more accurately predicts suicidal behavior

December 10, 2021

2 minute read


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Adding questions on the Suicidal Cognitions Scale to the commonly used Public Health Questionnaire-9 has improved the accuracy of screening for suicide risk in primary care clinics, the data shows.

From 1999 to 2017, the suicide rate in the United States increased by more than 33%, according to Craig J. Bryan, PsyD, ABPP, a board-certified clinical psychologist at Ohio State University Wexner Medical Center, and colleagues. Suicide rates have been rising “at an even faster rate” among service members and veterans, they wrote.

Nearly half of people who die by suicide had visited a primary care practice in the months immediately preceding their death, the researchers noted.

“Existing suicide risk screening methods, which focus on questions about suicidal ideation and/or planning, have very low specificity. As a result, screening in primary care results in very high false positive rates,” Bryan told Healio Primary Care. “This can result in the misallocation of limited resources and, for many patients, costly and potentially unnecessary interventions and treatments. Improving the accuracy of suicide risk screening by reducing false positives could therefore improve the care of patients who report suicidal ideation.

Bryan and his colleagues conducted a study to investigate potential strategies for improving suicide risk screening. The analysis included 2,744 patients from six military primary care clinics within the US Department of Defense healthcare system. The average patient age was 40.4 years, about half were male, and about two-thirds were Caucasian. All patients completed the Public Health Questionnaire-9 (PHQ-9) and 16 items of the Suicidal Cognitions Scale (SCS) during a routine primary care clinic visit.

The findings, published in Annals of Family Medicine, showed that 0.5% of patients had suicidal behavior within 30 days of screening and 1% had suicidal behavior within 90 days of screening.

Researchers reported that adding one or more SCS elements to PHQ-9 significantly improved screening. The 16 SCS items reduced the number of false positive results, according to Bryan. However, the two items that assessed patients’ level of agreement with the statements “It’s unbearable when I’m upset” and “I can’t imagine anyone could take this kind of pain” were considered ” the best because they dramatically improved accuracy without increasing the number of false negatives,” Bryan said.

Although previous tests indicated that the SCS is “a very good predictor of suicide risk,” the researchers were still “surprised that even a single element of the SCS could improve accuracy to such a great extent,” Bryan said. .

“The main finding of the study is that adding one or two items to the SCS may help clinicians better identify the subset of patients most likely to attempt suicide after screening positive on a screening tool. commonly used screening,” he said. “The results could therefore help clinicians better triage their patients who screen positive for suicide risk.”