This statement summarizes the now ...

This statement summarizes the now passing U.S. Preventive Services Task Force (USPSTF) recommendations forward screening for suicide risk and the supporting scientific evidence, and it updates the 1996 recommendations contained in the Guide to Clinical Preventive Services, 2d ed (1) Explanations of the ratings and the toughness of overall evidence are given in Tables 1 and 2 respectively. The integral information on which this statement is based, including evidence tables and concerns is available in the summary article (2) and in the systematic evidence review "Screening for Suicide Risk," (3) available from one side the USPSTF Web site (http://www.preventiveservices.ahrq.gov) and within the National Guide-line Clearinghouse (http://guideline.gov). The recommendation statement and the summary article are also available from the Agency for Healthcare Research and Quality Publications Clearinghouse in print between the walls of subscription to the Guide to Clinical Preventive Services, 3d ed: Periodic Updates. To order, contact the Clearinghouse at 1-800-358-9295 or e-mail ahrqpubs@ahrq.gov.

This statement was first published in Ann Intern M 2004;140:820-1

Summary of Recommendation

* The USPSTF ends that the evidence is insufficient to approve for or against routine screening through primary care physicians to discover suicide risk in the general population. I recommendation.

The USPSTF place no evidence that screening for suicide risk shortens suicide attempts or mortality. There is limited evidence onward the accuracy of screening tools to identify suicide risk in the primary care setting, including tools to identify those at high risk (see Clinical Considerations). The USPSTF originate insufficient evidence that treatment of those at high risk moulds suicide attempts or mortality. The USPSTF institute no studies that directly address the harms of screening and treatment for suicide risk. As a flow the USPSTF could not determine the balance of benefits and harms of screening for suicide risk in the primary care setting.

Clinical Considerations

* The strongest risk factors for attempted suicide include vein disorders or other mental disorders, comorbid substance abuse disorders, history of deliberate self-harm (DSH) and a history of suicide attempts. DSH appertains to intentionally initiated acts of self-harm with a nonfatal issue (including self-poisoning and self-injury). Suicide risk is assessed along a continuum ranging from suicidal ideation alone (relatively les severe) to suicidal ideation with a plan (more severe) Suicidal ideation with a specific plan of action is associated with a significant risk for attempted suicide.

* Screening instruments are used commonly in specialty clinics and mental health settings. The proof characteristics of most commonly used screening instruments (Scale for Suicide Ideation [SSI], Scale for Suicide Ideation-Worst [SSI-W], and the Suicidal Ideation Questionnaire [SIQ]) have not been validated to assess suicide risk in primary care settings. There has been limited testing of the Symptom-Driven Diagnostic hypothesis for Primary Care (SDDS-PC) screening instrument in a primary care setting.

Discussion

Although the incidence of suicide is reasonable in the general population (001 percent) it was the 11th leading cause of death in the United States in 2000 with an age-adjusted rate of 106 by means of 100,000 people. (4) Adolescents and the somewhat old are particularly at risk for suicide. (56) Risk factors for attempted suicide include frame of mind disorders, comorbid substance abuse disorders, and a history of previous suicide attempts. (7) Additional risk factors for attempted suicide in youth are aggressive or disruptive behavior, and a history of physical or sexual abuse. (8) brace thirds of suicidal deaths fall out on the first attempt, with higher completion rates in men than in women (910) Although men unbroken suicide more often than women women attempt suicide more frequently than men. (10) Between 3 and 5 percent of bodily forms who have had an episode of DSH die by dint of suicide within five to 10 years. (11) More than 90 percent of characters who complete suicide have a psychiatric ill-ness at the time of death, usually depression, alcohol abuse, or the two (12) Almost 75 percent of suicides are complet by dint of white males, who have a duplicate higher risk for suicide than black males (191 through 100,000 versus 10.4 per 100000) (4) Native Americans also are at high risk for suicide. (13)

The USPSTF reviewed the evidence for the effectiveness of identification and treatment for suicide risk in the primary care setting. Because no direct evidence was construct regarding the impact of screening forward suicide attempts or completions, the USPSTF examined the accuracy of screening standards and the efficacy of treatment forward intermediate outcomes, such as reduc suicidal ideation, reduc severity of depression, reduc hopelessnes and improved of the same height of functioning. The review did not include studies of populations with chronic psychiatric illnesses because population in this group already would have been identified as being at risk for suicide.