Short screener for suicidal behaviour in primary care - a systematic review

Abstract

We summarize the available studies reporting diagnostic accuracy of brief instruments for suicidal behaviour in primary care. Databases MEDLINE, EMBASE, PsychINFO, PSYNDEX, and Cochrane Library were searched without any time constraints. Risk of bias and applicability concerns were assessed using the QUADAS-2 tool. The certainty of evidence was rated via GRADEpro. We included studies on primary care patients or participants from the general population. Suicidal behaviour was the defined target condition. With respect to the applicability in a primary care setting we included only studies assessing brief screening instruments; a brief instrument was defined as having no more than 12 items. We assessed sensitivity, specificity, and positive and negative predictive value. A total of 12,460 studies were identified; of those, n = 7 fulfilled all strong criteria and were included. The range of sensitivity was 0.26-1.00, specificity was 0.64-0.99, positive predictive value 0.06-0.91, negative predictive value 0.83-1.00. Risk of bias was rated moderate and concerns regarding applicability acceptable. A required sensitivity of at least 0.80 and specificity of 0.50 with a moderate to high GRADE rating was achieved by 8 of 11 index tests. Brief screening instruments can support ruling-out suicidality, but are less suitable for ruling-in. They may support general practitioners in an initial assessment, but in case of a positive test result, a valid diagnostic assessment should be done by a structured clinical interview.