Abstract
Suicide screening is routine practice in psychiatric emergency (PE) departments, but evidence for screening instruments is sparse. Improved identification of nascent suicide risk is important for suicide prevention. The aim of the current study was to evaluate the association between the novel Colombia Suicide Severity Rating Scale Screen Version (C-SSRS Screen) and subsequent clinical management and suicide within 1 week, 1 month and 1 year from screening. Consecutive patients (N = 18 684) attending a PE department in Stockholm, Sweden between 1 May 2016 and 31 December 2017 were assessed with the C-SSRS Screen. All patients (52.1% women; mean age = 39.7, s.d. = 16.9) were followed-up in the National Cause of Death Register. Logistic regression and receiver operating characteristic curves analyses were conducted. Optimal cut-offs and accuracy statistics were calculated. Both suicidal ideation and behaviour were prevalent at screening. In total, 107 patients died by suicide during follow-up. Both C-SSRS Screen Ideation Severity and Behaviour Scales were associated with death by suicide within 1-week, 1-month and 1-year follow-up. The optimal cut-off for the ideation severity scale was associated with at least four times the odds of dying by suicide within 1 week (adjusted OR 4.7, 95% confidence interval 1.5-14.8). Both scales were also associated with short-term clinical management. The C-SSRS Screen may be feasible to use in the actual management setting as an initial step before the clinical assessment of suicide risk. Future research may investigate the utility of combining the C-SSRS Screen with a more thorough assessment.
Highlights
Suicide screening is routine practice in psychiatric emergency (PE) departments, but evidence for screening instruments is sparse
We identified cut-offs for the ideation severity scale that maximized the sum of sensitivity and specificity in this sample and accuracy statistics with 95% confidence intervals (CI) were calculated for all possible cutoffs
Our results may indicate – albeit not statistically significant – that inpatient care might provide immediate protection from death by suicide within a very brief time period (i.e. 1 week), inpatient care was not associated with decreased risk of suicide within 1 month or 1 year, on contrary absolute risks and the size of odds ratios (OR) may indicate that inpatient care could be an indicator of increased risk of suicide within 1 month and 1 year
Summary
Suicide screening is routine practice in psychiatric emergency (PE) departments, but evidence for screening instruments is sparse. 107 patients died by suicide during follow-up Both C-SSRS Screen Ideation Severity and Behaviour Scales were associated with death by suicide within 1-week, 1-month and 1-year follow-up. The optimal cut-off for the ideation severity scale was associated with at least four times the odds of dying by suicide within 1 week (adjusted OR 4.7, 95% confidence interval 1.5–14.8) Both scales were associated with short-term clinical management. Shorter actuarial tools or screening instruments for suicide risk may be based on a few items of risk indicators often including previous self-harm, previous psychiatric disorder, or previous psychiatric care contact Such scales have been studied in emergency departments and aim at improving the decision making if to refer a patient of high risk to psychiatric consultation (Steeg et al, 2012).
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