Center on Aging, University of Connecticut, Farmington, CT.
Sutter Health Center for Health Systems Research and Palo Alto Medical Foundation Research Institute, Sutter Health, Palo Alto, CA.
Transl Behav Med. 2023 Apr 15;13(4):193-205. doi: 10.1093/tbm/ibac117.
Implementation of suicide risk screening may improve prevention and facilitate mental health treatment. This study analyzed implementation of universal general population screening using the Columbia-Suicide Severity Rating Scale (C-SSRS) within hospitals. The study included adults seen at 23 hospitals from 7/1/2019-12/31/2020. We describe rates of screening, suicide risk, and documented subsequent psychiatric care (i.e., transfer/discharge to psychiatric acute care, or referral/consultation with system-affiliated behavioral health providers). Patients with suicide risk (including those with Major Depressive Disorder [MDD]) were compared to those without using Wilcoxon rank-sum -tests for continuous variables and χ2 tests for categorical variables. Results reported are statistically significant at p < 0.05 level. Among 595,915 patients, 84.5% were screened by C-SSRS with 2.2% of them screening positive (37.6% low risk [i.e., ideation only], and 62.4% moderate or high risk [i.e., with a plan, intent, or suicidal behaviors]). Of individuals with suicide risk, 52.5% had documentation of psychiatric care within 90 days. Individuals with suicide risk (vs. without) were male (48.1% vs 43.0%), Non-Hispanic White (55.0% vs 47.8%), younger (mean age 41.0 [SD: 17.7] vs. 49.8 [SD: 20.4]), housing insecure (12.5% vs 2.6%), with mental health diagnoses (80.3% vs 25.1%), including MDD (41.3% vs 6.7%). Universal screening identified 2.2% of screened adults with suicide risk; 62.4% expressed a plan, intent or suicidal behaviors, and 80.3% had mental health diagnoses. Documented subsequent psychiatric care likely underestimates true rates due to care fragmentation. These findings reinforce the need for screening, and research on whether screening leads to improved care and fewer suicides.
实施自杀风险筛查可以改善预防措施并促进精神卫生治疗。本研究分析了在医院使用哥伦比亚自杀严重程度评定量表（C-SSRS）对普通人群进行普遍筛查的实施情况。该研究纳入了 2019 年 7 月 1 日至 2020 年 12 月 31 日期间在 23 家医院就诊的成年人。我们描述了筛查率、自杀风险以及随后记录的精神科治疗情况（即转至精神科急性护理或与系统附属的心理健康提供者进行转介/咨询）。使用 Wilcoxon 秩和检验比较有自杀风险的患者（包括患有重度抑郁症的患者）和无自杀风险的患者之间的连续变量，使用卡方检验比较分类变量。报告的结果在 p < 0.05 水平具有统计学意义。在 595915 名患者中，84.5%接受了 C-SSRS 筛查，其中 2.2%筛查阳性（37.6%为低风险[即只有意念]，62.4%为中或高风险[即有计划、意图或自杀行为]）。在有自杀风险的个体中，52.5%在 90 天内有精神科治疗记录。与无自杀风险的个体相比，有自杀风险的个体为男性（48.1% vs 43.0%）、非西班牙裔白人（55.0% vs 47.8%）、年龄较小（平均年龄 41.0[SD：17.7] vs 49.8[SD：20.4]）、住房不稳定（12.5% vs 2.6%）、有精神健康诊断（80.3% vs 25.1%），包括重度抑郁症（41.3% vs 6.7%）。普遍筛查发现 2.2%接受筛查的成年人有自杀风险；62.4%表达了计划、意图或自杀行为，80.3%有精神健康诊断。随后记录的精神科治疗可能因治疗碎片化而低估了真实的比率。这些发现强化了筛查的必要性，以及筛查是否会带来更好的治疗和减少自杀的研究。
