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Abstract
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To the Editor:
We welcomed Bjureberg et al.'s (2021) study of the Columbia-Suicide Severity Rating Scale (C-SSRS) Screener's performance under the real-world clinical conditions of psychiatric emergency department (ED) practice (Bjureberg et al., 2021). Our group recently published on the performance of the C-SSRS Screener among a sample of 92 643 general medical ED and psychiatric ED patients in a safety net hospital in the United States (Simpson et al., 2020). When considering this research alongside our own recent work, it is clear that significant changes in suicide screening, screening research, and emergency psychiatric practice are warranted.
Together, these works provide much-needed data on performance of this screener. The Screener's original publication lacked crucial data related to its development, performance, and validation (Posner et al., 2011); only 10 years after its introduction can it be said that there are performance data with which to judge the Screener's utility in practice. The performance of the Screener at the one month and one year time periods are roughly similar in our two studies; these outcomes are compared in Table 1. In our study, the Screener did not demonstrate superior performance at higher risk strata, so in primary analyses we interpreted the risk as binary. There are some limitations to the current study. Bjureberg et al. note that 51% of their patients with a risk score of 3+ were hospitalized, which undoubtedly introduced a protected period for which they are at reduced risk of suicide and may understate risk associated with a higher C-SSRS scores (i.e. immortality bias). The team handled missing data by presuming that missing scores were missing at random - a likely incorrect presumption. Our own experience suggests that patients missing suicide screening data are at higher risk of suicide than those with negative screens. Regardless of these limitations, the case has been made that suicidal ideation is associated with subsequent risk of suicide after an ED visit. ...
Language: en |