Suicide Risk Assessment and Risk of Suicide in Schizophrenia: In Reply

In Reply: On behalf of the author group, I thank Dr. Large for his comments on our article. Screening for suicide risk among patients with schizophrenia cannot be done accurately, and when viewed as a diagnostic test, the currently used screening tools perform rather poorly. Thus it is natural to question the role of systematic suicide risk assessment in modern psychiatry.

However, systematic suicide risk assessment remains widely used across health care systems. This practice is rational if the systematic assessment is not used as a stand-alone diagnostic test with a dichotomous outcome. Instead, it should be considered a tool to supplement direct observation and interviews with the patient and his or her close relatives or friends. A systematic and structured approach is in our opinion a prerequisite for fulfilling the overall aim stated by Dr. Large—that all patients “should be offered individualized, optimized care to improve well-being and thereby reduce the likelihood of their taking their own lives.”