Citation

Rudd MD. Psychol. Med. 2021; ePub(ePub): ePub.

Copyright

(Copyright © 2021, Cambridge University Press)

DOI

10.1017/S0033291721002750

PMID

unavailable

Abstract

Simpson, Loh, and Goans (2021) make an excellent point about the recent C-SSRS Screener findings, calling for new approaches in research and clinical practice targeting suicide risk assessment in light of poor predictive value estimates in real-world clinical settings like emergency departments. Their recommendation is bolstered substantially by the large sample sizes of both studies cited (N = 18 684 and N = 92 643), coupled with 30-day and 365-day after ED-visit suicide outcome data. In addition to the recommendation offered by Simpson et al. (2021), these findings reveal a broader problem for research and clinical practice focused on suicide risk assessment, that is, a potential failure to recognize flawed or unacknowledged underlying assumptions driving the effort in some clinical arenas, particularly healthcare and clinical settings.

The use of psychometrically sound screening tools targeting suicidal thoughts have been almost uniformly recommended as a best practice, regardless of clinical setting and related data on predictive value. Suicide risk screening in healthcare settings is undeniably important, with over 80% of those later dying by suicide having been actively engaged in the healthcare system in the year prior, and 50% within the past month. The largest percentage of those dying by suicide after entering the healthcare system pass through primary care settings and emergency departments (National Alliance for Suicide Prevention: Transforming Health Systems Initiative Work Group, 2018). However, the idea that people are 'falling through the cracks' is not entirely accurate, as it assumes existing tools are designed to effectively engage and uniformly assess those at significant risk for suicide. As recent C-SSRS data reveal, there may be a more fundamental problem to consider. We may not need better screening tools. Rather, we may need different tools developed for different clinical settings driven by different underlying assumptions in accordance with available data.

Recent findings using ecological momentary assessment (ECA) suggest that large numbers of those at risk for suicide in healthcare settings may not be unwilling to disclose...

Language: en