U.S. Preventive Services Task Force rejects routine screening for suicidality

[Altostrata]

Just about everyone has one or more of the risk factors for suicide; they are not predictive.

 

http://www.medpagetoday.com/PrimaryCare/GeneralPrimaryCare/45924
USPSTF: Routine Suicide Screens Not Beneficial

Published: May 21, 2014
By Sarah Wickline, Staff Writer, MedPage Today

Screening for suicide risk in adolescent, adult, and senior patients in the absence of definite risk factors has no proven benefit in the primary care setting, the U.S. Preventive Services Task Force (USPSTF) said.

In an update to a 2004 recommendation, which also found insufficient evidence to support suicide screening, the USPSTF found that neither benefits nor harms from routine suicide risk screening could be determined on the basis of existing research.
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"The USPSTF recognizes that clinical decisions involve more considerations than evidence alone. Clinicians should understand the evidence but individualize decision making to the specific patient or situation," wrote lead author Michael L. LeFevre, MD, MSPH, of the University of Missouri School of Medicine in Columbia, on behalf of the panel.

In 2010, suicide ranked as the 10th leading cause of death in the U.S., and one of five leading causes of death for persons ages 10 to 54 with nearly 37,000 deaths. In 2011, 7.8% of high school students said that they had attempted suicide, 2.4% of students made a suicide attempt that resulted in injury, and 3.7% of adults 18 years or older said they had experienced serious thoughts of suicide in the past year.

The finding of no proven benefit only applies to patients without certain risk factors, the USPSTF noted. The following are risk factors that may increase the likelihood of a suicide attempt:

• The presence of a mental health disorder
• Serious adverse events in childhood
• A family history of suicide
• Experiencing discrimination based on sexual orientation
• Access to dangerous, lethal means to commit suicide
• History of being bullied
• Trouble sleeping
• Chronic medical conditions

Research has shown that some populations have particular risk factors, according to the report. For males, these included socioeconomic stressors, such as low income or unemployment. For seniors, risks were associated with social isolation, the death of a spouse, functional impairment, neurosis, or physical illness. And for military veterans, the risk of suicide was greater for those with traumatic brain injury, discharged within the past year, or post-traumatic stress or other mental health conditions.

But having a single risk factor is of "limited" value in assessing suicide risk, the task force indicated. It noted that many if not most Americans have at least one risk factor for suicide, yet only a small fraction of them actually attempt suicide, "and even fewer will die by it."

Screening instruments developed for primary care include the 20-item Suicide Risk Screen and as well as a briefer tool that queries patients about "thoughts of death," "wishing you were dead," and "feeling suicidal" within the past month. In general, sensitivity and specificity of such tools ranged from 52% to 100% and 60% to 98%, respectively, the USPSTF found.

The task force .... recommend screening adolescents and/or adults for depression, which is a major risk factor not only for suicidality but also for a range of other adverse health outcomes.

For patients deemed to be at risk for suicide, the task force report included some information on treatments. Psychotherapy has been shown to be an effective intervention. In particular, cognitive behavioral therapy and related approaches -- such as dialectical behavioral therapy, problem-solving therapy, and developmental group therapy -- were among the most studied therapies to reduce suicide risk.

Primary source: Annals of Internal Medicine
http://annals.org/article.aspx?articleid=1872851 LeFevre M, et al "Screening for suicide risk in adolescents, adults, and older adults in primary care: U.S. preventive services task force recommendation statement" Ann Intern Med 2014; DOI: 10.7326/M14-0589.