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teaching:suicide-risk-assessment-sra [on April 30, 2020]
teaching:suicide-risk-assessment-sra [on March 7, 2024] (current)
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%. More robust studies estimate this to be at 20%.[([[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
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 <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>​