Brief Screening Tool Could Be Used to Assess Suicide Risk

One thing missing from the PHQ-2 screening tool for depression is a way to identify teens at risk for suicide (see Depression Screening Can't Get Much Briefer Than This). However, a small study conducted at three clinics indicates that some physician training and two questions for patients could raise rates of inquiry and case detection of suicidality, according to Matthew Wintersteen, Ph.D., an assistant professor in the Department of Psychiatry and Human Behavior at Thomas Jefferson University in Philadelphia. His results appear in the May Pediatrics.

Clinic providers were offered a 90-minute training session on the epidemiology of youth suicide, along with risk and protective factors, assessment, clinical management, and treatment. Then two items were added to the standard electronic psychosocial screen used in the clinics. One question inquired about thoughts of death without suicidal ideation: “Have you ever thought that life was not worth living?”The second directly addressed suicidal ideation: “Have you ever felt like you wanted to kill yourself?”

Patients who answered yes to either question were then automatically asked a series of six additional questions covering suicidal ideation, preparation, and attempts.

Wintersteen compared pre- and post-intervention rates of inquiry and identification.

Overall, the rate of clinicians who inquired about suicidality more than doubled, from 36.5 percent to 82.1 percent (odds ratio = 2.49), wrote Wintersteen. The rate of youth detected with suicidal ideation rose from 0.8 percent to 3.6 percent (OR = 4.33). Rates of referrals to behavioral health services paralleled the increase in detection rates.

While these increases seem large, the absolute numbers were still manageable, said Wintersteen. For instance, 13 adolescents were identified before the intervention and 51 after—“approximately one youth per week over a 12-month period”—out of a 2,000-patient caseload.

While the study suggests that primary care providers can detect young people at risk for suicidality, the provider's time and the availability of referral resources still remain obstacles to broader implementation, said Wintersteen.

An abstract of “Standardized Screening for Suicidal Adolescents in Primary Care” is posted at <http://pediatrics.aappublications.org/cgi/content/abstract/peds.2009-2458v1>.