Which sources of information should be utilized in the assessment of suicidal patients?

Updated: Aug 29, 2019
  • Author: Stephen Soreff, MD; Chief Editor: Glen L Xiong, MD  more...
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Answer

Answer

Utilize all of the information available when assessing suicide risk. In addition to the material obtained through the clinical interview, use information from other sources, including family interviews or interviews with friends or coworkers. First responders or other medical personnel may also have key information. In addition, a suicide note may have been written.

A number of written and online tests will indicate the presence of a significant depression and significant thoughts and plans for self-destruction. These include the following self-administered tests:

  • Beck Depression Inventory

  • Hamilton Depression Rating Scale

  • HANDS (Harvard Department of Psychiatry/National Depression Screening Day Scale) Depression Screening Questionnaire [122]

  • Minnesota Multiphasic Personality Inventory (MMPI)

Constant thoughts of death or self-harm appear to be highly indicative of suicide risk. Patients who think about death or self-harm "nearly every day" as evidenced by their response to a particular question on the Patient Health Questionnaire (PHQ-9) are at greater risk for making a suicide attempt compared with those who do not have these types of thoughts. [123, 124]

In a study of 84,418 individuals with depressive symptoms who completed the PPHQ-9 at every outpatient visit for depression over a 4-year period, researchers found that patients who reported in response to Item 9 ("Over the last 2 weeks, how often have you been bothered by thoughts that you would be better off dead, or of hurting yourself in some way?") that they thought about death or self-harm "nearly every day" accounted for 53% of suicide attempts during the study period and 54% of the suicide deaths. [123, 124] Those who responded "nearly every day" to Item 9 had a relative hazard ratio (HR) of 6.37 for suicide attempt, and individuals who responded "more than half the days" had a relative HR of 4.12. A 91% increase in risk was observed with each one-step increase in the reported frequency of thoughts of death or self-harm. [123, 124]

Using the Collaborative Longitudinal Study of Personality Disorders (CLPS), Yen et al found that the predictive power of the self-harm subscale of the Schedule for Nonadaptive and Adaptive Personality (SNAP) may be a helpful screening tool for risk of suicide attempts in nonpsychotic psychiatric patients. [125]

Ballard et al, in a study to determine how children react to suicide screening in an emergency department (ED), suggested that pediatric patients supported suicide screening in the ED. Further studies are needed to evaluate the impact of such screening on referral practices and to link screening efforts with interventions. [126]

According to one study, long-term health histories found in electronic health records (EHR) can be useful for predicting future risk of suicidal behavior. [127]  Researchers used EHR data from a large cohort of patients in the Boston area spanning 15 years (1998–2012) to predict future documented suicidal behavior. Their model achieved 33%–45% sensitivity, 90%–95% specificity, and early (3–4 years in advance on average) prediction of patients' future suicidal behavior. 

A combination blood test and clinical questionnaire developed by researchers in Indiana was found to predict suicidal ideation with about 92%accuracy in people diagnosed with depression, bipolar depression, schizophrenia, or schizoaffective disorder. [128]  For bipolar disorder, it predicted suicidal ideation with 98% accuracy, and future hospitalizations with 94% accuracy. The group integrated the top 11 suicide biomarkers as screened for in a blood test and the clinical information gleaned from the Convergent Functional Information for Suicide (CFI-S) and Simplified Affected State Scale (SASS) patient assessments into a universal predictive measure (UP-Suicide).


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