Screening To Identify Primary Care Patients Who Are at Risk for Suicide: Recommendations from the U.S. Preventive Services Task Force

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The summary below is from the full reports titled "Screening for Suicide Risk: Recommendation and Rationale" and "Screening for Suicide Risk in Adults: A Summary of the Evidence for the U.S. Preventive Services Task Force." They are in the 18 May 2004 issue of Annals of Internal Medicine (volume 140, pages 820-821 and pages 822-835). The first report was written by the U.S. Preventive Services Task Force; the second report was written by B.N. Gaynes, S.L. West, C.A. Ford, P. Frame, J. Klein, and K.N. Lohr.

What is the U.S. Preventive Services Task Force?

The U.S. Preventive Services Task Force (USPSTF) is a group of health experts that reviews published research and makes recommendations about preventive health care. The USPSTF and its review of the published research are supported by the Agency for Healthcare Research and Quality (AHRQ).

What is the problem and what is known about it so far?

Suicide (intentionally killing oneself) was the 11th most common cause of death in the United States in 2000. Adolescence and old age are the times in life when suicide is most common. People who have mood disorders such as depression or drug or alcohol abuse or who have previously tried to kill themselves (suicide attempt) are more likely to commit suicide than people who do not have any of these conditions. Suicide is also more frequent among adolescents who behave aggressively or who have been victims of physical or sexual abuse than among those without these problems. Because more than 10 out of every 100 000 Americans will die as a result of suicide, the USPSTF wanted to determine whether screening for suicide risk should be a routine part of primary medical care. Screening means looking for a condition in people who do not have any outward signs or symptoms of the condition.

How did the USPSTF develop these recommendations?

The USPSTF reviewed published research about the benefits and harms of screening for suicide risk.

What did the authors find?

The authors found that although screening questionnaires about suicide risk exist, they have been studied mostly in mental health settings. The accuracy of these questionnaires in identifying general primary care patients who are at risk for suicide is unknown. The authors also found very few studies showing that treating people who screen positive for suicide risk reduces suicides or suicide attempts. Furthermore, no existing studies directly address the potential harms of screening for suicide.

What does the USPSTF suggest that patients and doctors do?

The USPSTF recommends neither for nor against screening for suicide as part of routine primary care. Of course, doctors and patients should address suicide risk during primary care medical encounters if either believes a patient is in danger of intentionally harming himself or herself. The USPSTF also has a separate recommendation for screening for depression that can be accessed at http://www.ahrq.gov/clinic/uspstf/uspsdepr.htm.

What are the cautions related to these recommendations?

These recommendations may change as new studies become available.