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teaching:suicide-risk-assessment-sra [on April 30, 2020] |
teaching:suicide-risk-assessment-sra [on March 7, 2024] psychdb [Sobering Statistics] |
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| ====Do Suicide Risk Assessments Work?==== | ====Do Suicide Risk Assessments Work?==== | ||
| - | Suicide risk assessments setting have poor predictive value in identifying those at risk actually of completing suicide.[([[http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0156322|Large, M., Kaneson, M., Myles, N., Myles, H., Gunaratne, P., & Ryan, C. (2016). Meta-analysis of longitudinal cohort studies of suicide risk assessment among psychiatric patients: heterogeneity in results and lack of improvement over time. PloS one, 11(6), e0156322.]])] However, a structured risk assessment remains a core skill in order to appropriately plan disposition for patients with suicidal ideation and also for medicolegal purposes. | + | Suicide risk assessments setting have poor predictive value in identifying those at risk actually of completing suicide.[([[http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0156322|Large, M., Kaneson, M., Myles, N., Myles, H., Gunaratne, P., & Ryan, C. (2016). Meta-analysis of longitudinal cohort studies of suicide risk assessment among psychiatric patients: heterogeneity in results and lack of improvement over time. PloS one, 11(6), e0156322.]])] However, a structured suicide risk assessment remains a core skill in order to appropriately plan disposition for patients with suicidal ideation and also for medicolegal record keeping. |
| ==== Sobering Statistics ==== | ==== Sobering Statistics ==== | ||
| - | * 95% of high risk patients will not die by suicide[([[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4902221/|Large, M., Kaneson, M., Myles, N., Myles, H., Gunaratne, P., & Ryan, C. (2016). Meta-analysis of longitudinal cohort studies of suicide risk assessment among psychiatric patients: heterogeneity in results and lack of improvement over time. PloS one, 11(6), e0156322.]])] | + | * 95% of "high risk" patients will not die by suicide[([[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4902221/|Large, M., Kaneson, M., Myles, N., Myles, H., Gunaratne, P., & Ryan, C. (2016). Meta-analysis of longitudinal cohort studies of suicide risk assessment among psychiatric patients: heterogeneity in results and lack of improvement over time. PloS one, 11(6), e0156322.]])] |
| - | * There is no validated method to identify patients at high risk who would improve with treatment/hospitalization | + | * There is no validated method to identify patients at high risk who would improve with treatment/hospitalization. |
| - | * 50% of suicides are from low risk patients | + | * 50% of suicides are from "low risk" patients.[([[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4902221/|Large, M., Kaneson, M., Myles, N., Myles, H., Gunaratne, P., & Ryan, C. (2016). Meta-analysis of longitudinal cohort studies of suicide risk assessment among psychiatric patients: heterogeneity in results and lack of improvement over time. PloS one, 11(6), e0156322.]])] |
| - | * 50% of individuals who successfully commit suicide have no prior history of suicide attempts | + | * 50% of individuals who complete suicide have no prior history of suicide attempts. |
| - | * There has been no improvement of accuracy of predicting suicides in the past 40 years | + | * Not all people who die by suicide have a psychiatric disorder. |
| + | * In Western high-income countries, the percentage of those who die by suicide with no psychiatric disorder is estimated to be between 5% and 40%.[([[https://pubmed.ncbi.nlm.nih.gov/38381442/|Oquendo, M. A., Wall, M., Wang, S., Olfson, M., & Blanco, C. (2024). Lifetime suicide attempts in otherwise psychiatrically healthy individuals. JAMA psychiatry.]])] | ||
| + | * There has been no improvement of accuracy of predicting suicides in the past 40 years, despite other advances in medicine, which speaks to the complexity of suicide as an outcome. | ||
| <alert icon="fa fa-arrow-circle-right fa-lg fa-fw" type="success">See also: **[[teaching:suicide]]**</alert> | <alert icon="fa fa-arrow-circle-right fa-lg fa-fw" type="success">See also: **[[teaching:suicide]]**</alert> | ||
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| </WRAP> | </WRAP> | ||
| + | ===== Screening and Rating Scales ==== | ||
| + | <panel title="Suicide Assessment Scales" no-body="true"> | ||
| + | <mobiletable 1> | ||
| + | ^ Name ^ Rater ^ Description ^ Download ^ | ||
| + | ^ Columbia-Suicide Severity Rating Scale (C-SSRS)[([[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3893686/|Posner, K., Brown, G. K., Stanley, B., Brent, D. A., Yershova, K. V., Oquendo, M. A., ... & Mann, J. J. (2011). The Columbia–Suicide Severity Rating Scale: initial validity and internal consistency findings from three multisite studies with adolescents and adults. American journal of psychiatry, 168(12), 1266-1277.]])] | Clinician | The Columbia-Suicide Severity Rating Scale (C-SSRS) is a tool that uses a series of questions to assess suicide risk. | [[https://cssrs.columbia.edu/|Link]] | | ||
| + | </mobiletable> | ||
| + | </panel> | ||
| ===== Documentation and Disposition ===== | ===== Documentation and Disposition ===== | ||
| <WRAP group> | <WRAP group> | ||
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| The mnemonic ''**CAIPS**'' can be a good way to structure your suicide risk assessment documentation on the medical record: | The mnemonic ''**CAIPS**'' can be a good way to structure your suicide risk assessment documentation on the medical record: | ||
| * ''**C**'' - **Chronic Factors** | * ''**C**'' - **Chronic Factors** | ||
| + | * (e.g. - Past history of suicide attempts, history of self-harm) | ||
| * ''**A**'' - **Acute Factors** | * ''**A**'' - **Acute Factors** | ||
| + | * (e.g. - Recent break up, job loss, or acute crisis) | ||
| * ''**I**'' - **Imminent Warning Signs** | * ''**I**'' - **Imminent Warning Signs** | ||
| + | * (e.g. - Means of death has been prepared, such as buying a gun, or having imminent access to the means of death) | ||
| * ''**P**'' - **Protective Factors** | * ''**P**'' - **Protective Factors** | ||
| + | * (e.g. - "Supportive family, help-seeking, willing to safety plan, future-oriented, willing to attend follow up) | ||
| * ''**S**'' - **Summary Statement** | * ''**S**'' - **Summary Statement** | ||
| + | * (e.g. - "Based on the factors above, patient is at [low/medium/high] risk for suicide) | ||
| </WRAP> | </WRAP> | ||
| <WRAP half column> | <WRAP half column> | ||
| ==== Other Considerations ==== | ==== Other Considerations ==== | ||
| - | Consider the following in your decision to discharge: | + | Consider the other following factors in your decision to discharge/admit: |
| - Diagnosis | - Diagnosis | ||
| - Severity of suicidal ideation | - Severity of suicidal ideation | ||
| Line 73: | Line 86: | ||
| <WRAP half column> | <WRAP half column> | ||
| ==== Safety Planning ==== | ==== Safety Planning ==== | ||
| + | * {{ :teaching:coping_with_suicidal_thoughts.pdf |Coping with Suicidal Thoughts}} | ||
| * {{ ::safety-comfort-plan.pdf |Safety and Comfort Plan}} | * {{ ::safety-comfort-plan.pdf |Safety and Comfort Plan}} | ||
| * {{ ::coping-card-170308-acc.pdf |Coping Card}} | * {{ ::coping-card-170308-acc.pdf |Coping Card}} | ||
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| * {{ ::how_to_write_a_suicide_risk_assessment_that-s_clinically_sound_and_legally_defensible.pdf |How to Write a SRA}} | * {{ ::how_to_write_a_suicide_risk_assessment_that-s_clinically_sound_and_legally_defensible.pdf |How to Write a SRA}} | ||
| * {{ :apa_suicide_risk_assessment.pdf | Suicide Risk Assessment (APA) }} | * {{ :apa_suicide_risk_assessment.pdf | Suicide Risk Assessment (APA) }} | ||
| - | * {{ :on-call:camh:camh_suicide_risk_assessment_template.pdf | Suicide Risk Assessment Template (CAMH)}} | + | * {{ :suicide_risk_assessment_template.pdf | Suicide Risk Assessment Template (CAMH)}} |
| </WRAP> | </WRAP> | ||