Citation

Caine ED. Ann. Intern Med. 2019; ePub(ePub): ePub.

Affiliation

University of Rochester Medical Center, Rochester, New York (E.D.C.).

Copyright

(Copyright © 2019, American College of Physicians)

DOI

10.7326/M19-2347

PMID

31450242

Abstract

Suicide's dramatic rise in the United States during the first years of the 21st century has resisted persistent efforts—involving the general population, veterans, and military personnel—to turn the tide. The U.S. suicide rate in 2000 (the base year for standardized comparison) was 10.40 per 100 000 persons; by 2017, the crude rate had climbed by 39% to 14.48, taking 47 173 lives (1). It often has seemed as if powerful external forces beyond our control have propelled vulnerable persons over the edge to their death.

As a clinician for many years, I felt that I could make a difference in the lives of my patients. As a public health professional, I must admit that efforts like mine and those of others have not stemmed the larger trends that we see so clearly now. It is in this context, one of dedicated efforts and realistic self-appraisal, that we need to consider the new clinical practice guidelines from the U.S. Department of Veterans Affairs (VA) and the U.S. Department of Defense (DoD), “Assessment and Management of Patients at Risk for Suicide,” based on expert consensus (2) and a systematic literature review from the ECRI Institute (3). This work presents the state of the evidence, in terms of not only achievements but also how little we know with certainty. Let's consider.

The guidelines necessarily reflect the priorities of the VA and the DoD, though they are presented as generalized versions of care potentially suitable for adults seen...

Language: en