Screening tools in the primary care setting may help identify some adults at increased risk for suicide, but the tools have limited ability to detect suicide risk in adolescents, say the authors of an evidence review prepared for the US Preventive Services Task Force and appearing online today in the Annals of Internal Medicine. The evidence review was undertaken to assist the task force as it prepares to update its 2004 recommendation on suicide risk screening, which stated there was insufficient evidence to recommend for or against routine screening of the general population by primary care clinicians.
In 2009, suicide accounted for 36 897 deaths in the United States, making it the 10th leading cause of death. The authors noted that 38% of US adults who completed suicide visited their primary care providers in the prior month, a rate that increased to 70% in older adults. And nearly 90% of youths with suicidal thoughts had primary care visits during the previous 12 months, compared with 70% to 80% of youth who did not report thoughts of suicide. It has been suggested that screening tools that are accurate and feasible for use in primary care could provide an opportunity to identify persons at increased risk, enabling them to receive appropriate treatment to prevent suicide.
The authors note that suicide risk can be difficult to assess accurately, and even in high-risk populations, suicide is comparatively rare. Also, the known risk factors are relatively common and are not very strong predictors of suicide, even in those at high risk. Furthermore, even if at-risk individuals are identified through screening, the evidence that treatment is beneficial is weak.
In a combined assessment of all studies of psychotherapy reviewed by the authors, they found that psychotherapy targeting suicide prevention reduced attempted suicide among adults by an estimated 32%; however, most of the psychotherapy trials were done in high-risk populations, typically individuals with a recent suicide attempt or a mental health disorder and a history of suicide attempts. How this reduction in suicide attempts translates to the general population remains unknown. And the authors found that psychotherapy remains unproven as an effective intervention for high-risk adolescents.