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Affiliation
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Department of Psychiatry, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada. |
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Abstract
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OBJECTIVE: To compare the effectiveness of clinician prediction of risk to a standardized assessment of presentation status.
METHODS: All adult psychiatry emergency department consults in the two main hospitals in Winnipeg, Canada, were assessed using a standardized form (n = 5,376). This form includes two risk scales for a gestalt physician assessment of risk (Suicide Likelihood scale, suicide Attempt Likelihood scale) and the Columbia Classification Algorithm of Suicide Assessment (C-CASA). Regression determined whether assessments predicted future suicide attempts and deaths. The area under the curve (AUC) determined the prediction accuracy of these methods.
RESULTS: Although the regression results were significant, the AUCs were either moderate or poor. Clinician assessment was not effective at predicting deaths (AUC = .546,.36-.73), but moderately accurate at predicting future attempts (AUC = .728,.66-.79). C-CASA assessment was moderately accurate at predicting both attempts and deaths (AUC = .666 and.678).
CONCLUSIONS: Clinician assessment does not significantly outperform a simple assessment of the occurrence of suicidal thoughts and behaviors during presentation to the emergency department. Behavior-based standardized assessments should be further researched in this field. Assessment of suicidality at presentation using C-CASA or similar assessment should be standard for psychiatric patients assessed in the emergency department.
© 2018 The American Association of Suicidology.
Language: en |