Wednesday, May 21, 2014

Preventive Services Task Force Finds Insufficient Evidence for Suicide Screening in Primary Care

Evidence for the effectiveness of screening for suicide in primary care practices appears to be insufficient and is not recommended, according to a report in Annals of Internal Medicine by the United States Preventive Services Task Force (USPSTF).

The USPSTF reviewed evidence on the accuracy and reliability of instruments used to screen for increased suicide risk, benefits and harms of screening for increased suicide risk, and benefits and harms of treatments to prevent suicide. The reviewed studies used various screening tools targeting primary care patients aged 18 to 70.

The sensitivity and specificity of screening tools generally ranged from 52% to 100% and from 60% to 98%, respectively. The instruments showed a wide range in accuracy, but data were limited and no instruments were examined in more than one study.

The USPSTF concluded that the current evidence is insufficient to assess the balance of benefits and harms of screening for suicide risk in adolescents, adults, and older adults in a primary care setting.

“Screening for suicide (not suicidal behaviors) has a low specificity and sensitivity rate,” said Jan Fawcett, M.D., who was chair of the DSM-5 Mood Disorder Work Group and Suicide Sub-Work Group. “What should the primary care physician do to prevent the predicted suicide? Send the patient to an ER? Try to admit the patient involuntarily for psychiatric care? There is no evidence that the PCP [primary care provider] can prevent a suicide, much less determine which patients scoring high on the scale are `really’ suicidal. Why should the PCP want to accumulate high suicide screens if they cannot do anything about them and can be held liable for not being successful?.... Perhaps teaching PCPs to evaluate, treat, and refer suicidal depression patients would be more useful than using untested check lists from patients.”

For more information about suicide-related issues, see the Psychiatric News article, “Suicide Experts Identify Six Questions to Guide Research in Next Decade.” Also see American Psychiatric Publishing's “Textbook of Suicide Assessment and Management, Second Edition.”

(Image: Dirk Ercken/


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