Instruments for the assessment of suicide risk: A systematic review evaluating the certainty of the evidence

Runeson, Bo; Odeberg, Jenny; Pettersson, Agneta; Edbom, Tobias; Adamsson, Ingalill Jildevik; Wærn, Margda

doi:10.1371/journal.pone.0180292

Cited by 195 publications

(160 citation statements)

References 55 publications

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“…A meta-analysis of five instruments across the studies showed that none of the instruments reached the predetermined benchmarks (80% sensitivity and 50% specificity) for the suicide outcome or suicide attempt outcome. With few exceptions, low figures were observed for the positive predictive value for the suicide outcome (1-13%) 83. This review, however, did not include the diagnostic accuracy of the Suicide Assessment Scale (SUAS) or the Columbia Suicide Severity Rating Scale (C-SSRS).…”

Section: Depression and Suicide Riskmentioning

confidence: 99%

Depression in primary care: part 1—screening and diagnosis

Ferenchick

Ramanuj

Pincus

2019

BMJ

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Depression is a common and heterogeneous condition with a chronic and recurrent natural course that is frequently seen in the primary care setting. Primary care providers play a central role in managing depression and concurrent physical comorbidities, and they face challenges in diagnosing and treating the condition. In this two part series, we review the evidence available to help to guide primary care providers and practices to recognize and manage depression. In this first of two reviews, we outline an approach to screening and diagnosing depression in primary care that evaluates current evidence based guidelines and applies the recommendations to clinical practice. The second review presents an evidence based approach to the treatment of depression in primary care, detailing the recommended lifestyle, drug, and psychological interventions at the individual level. It also highlights strategies that are being adopted at an organizational level to manage depression more effectively in primary care.

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Section: Depression and Suicide Riskmentioning

confidence: 99%

Depression in primary care: part 1—screening and diagnosis

Ferenchick

Ramanuj

Pincus

2019

BMJ

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“…However, this contradicts recommendations which suggest that locally developed risk assessment tools that lack an evidence base should be abandoned . Furthermore, recent findings show that the SAD PERSONS scale is not statistically reliable, and should not be used in its present form …”

Section: Introductionmentioning

confidence: 99%

Suicide risk assessment in the emergency department: An investigation of current practice in Scotland

et al. 2019

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Background Suicide is a global public health issue. Approximately one third of individuals who complete suicide have attended an emergency department in the year preceding their death. The aim of this study was to investigate current suicide risk assessment practices across emergency department clinicians in Scotland. Methods A mixed‐methods design was employed. A total of 112 surveys for emergency department clinicians were posted to 23 emergency departments in Scotland between March and September 2016. Follow‐up semi‐structured interviews were also conducted exploring clinician's experiences of suicide risk assessment. Interviews were analysed using thematic analysis. Results Fifty‐one emergency department clinicians across 17 emergency departments completed the survey. Thirty‐five (68.6%) participants were currently using a suicide risk assessment tool; with most using locally developed tools and proformas (n = 20, 62.5%) or the SAD PERSONS scale (n = 13, 40.6%). Remaining participants (n = 16, 31.4%) did not use suicide risk assessment tools during assessment. Variation in practice was found both across and within emergency departments. Six clinicians participated in follow‐up interviews, which identified four major themes: Clinician Experiences of Suicide Risk Assessment; Components of Suicide Risk Assessment; Clinical Decision‐Making; and Supporting Clinicians. Conclusions There is substantial variation in current practice, with around two‐thirds of clinicians using a variety of empirically and locally developed tools, and a third using their judgement alone. Clinicians find suicide risk assessment a challenging part of their role and discuss the need for increased training, and appropriate and helpful guidelines to improve practice.

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“…Still, only a few countries have included suicide prevention among their health priorities, and only 28 countries report having a national suicide prevention strategy. So, even today, little is known about how to make proper suicide risk assessments (Runesson et al, ). MHPs with extensive experience can have expert knowledge, which is intuitive (Benner, ).…”

Section: Introductionmentioning

confidence: 99%

The borderline between life and death

Hultsjö

Wärdig

Rytterström

2019

Journal of Clinical Nursing

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Aims and objectives To explore mental health professionals’ experiences in regard to circumstances that cause the patient to take their own life during ongoing care. Background Suicide is a worldwide health problem, and of those who take their own life, nearly 20% have had contact with a psychiatric unit. Mental health professionals may have extended intuitive knowledge that has not been made visible. Mental health professionals’ experiences can contribute knowledge that can complement suicide risk assessments and can be helpful in developing approaches and strategies where the hope is to identify and draw attention to people at risk of taking their own life. Design A reflective lifeworld research. Methods Twelve interviews with mental health professionals with experience of working in caring relationships with patients that had taken their life during the period of care. The study was performed in accordance with COREQ (see Supporting Information Data S1). Results Mental health professionals’ experiences regarding circumstances that cause the patient to take their own life are related to the patient’s life circumstances that led to a loss of dignity, and finally beyond retrieval. Mental health professionals share patients’ struggle to choose between life and death, the darkness of their life and their hopeless situation. This shared experience also makes the mental health professionals wish to relieve patient’s suffering but also gives them an understanding of why patients take their own life. Conclusions The mental health professionals experience how the patient loses the possibility of living a worthwhile life, recognise darkness within the patient and see how the patient’s life is fragile. Suicide described as logical and expected, based on their life and life circumstances, has not been found in previous research. Bearing this in mind, should psychiatric care focus on a proactive approach and act when these circumstances are identified? Relevance to clinical practice The Mental health professionals’ tacit knowledge may be used to strengthen uncertain suicide assessments.

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Instruments for the assessment of suicide risk: A systematic review evaluating the certainty of the evidence

Cited by 195 publications

References 55 publications

Depression in primary care: part 1—screening and diagnosis

Depression in primary care: part 1—screening and diagnosis

Suicide risk assessment in the emergency department: An investigation of current practice in Scotland

The borderline between life and death

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