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We are pleased to introduce the second in a short series of articles in
Partners in Health UpdateSM, "Suicide: A concern for all
health care providers," that is designed to provide you with information on
suicide and the importance of your role in assessing your patients who may be
at risk.
Part 2 ? Embracing your role through screening, assessing,
and promoting safety for individuals at risk for suicide
In part one of this series, we addressed your role as a health care provider
in assessing the risk of suicide. Here we are offering information on how you
can screen and intervene when you believe a patient is suicidal. For primary
care physicians (PCP), OB/GYNs, and Behavioral Health providers (BHP), the use
of screening tools can promote safety. An advantage to using screening tools is
the common language that PCPs, OB/GYNs, and BHPs need to effectively
communicate.1 Below are three of the many tools you can explore for
use in your practice:
- PHQ-9. One of the more familiar screening tools for
depression is the PHQ-9. This tool gives vital information about depression,
which is a significant contributor to an increase in the risk for suicide.
Although this tool has only one question that directly addresses thoughts of
suicide, it could help show that the patient is at risk. In addition, there are
specific suicide screening tools available that, when used in conjunction with
the PHQ-9, can explore the issue of suicidality more fully.
- SAFE-T. The Substance Abuse and Mental Health Services
Administration (SAMHSA) offers several tools on their website, and many of them can
be used without cost. One of these is the Suicide Assessment Five-Step
Evaluation and Triage (SAFE-T) tool, which identifies risk and protective
factors, inquires about suicidal thoughts, determines risk levels, and makes
recommendations for intervention and follow-up. In addition to the SAFE-T tool,
you can find information on SAMHSA's website regarding the SAFE-T suicide
prevention app for mobile devices.2
- Columbia Suicide Severity Rating Scale. The National
Action Alliance for Suicide Prevention supports Zero Suicide and wants health
care providers to see suicide as preventable. Through the Zero Suicide website, you
can obtain information and education about another valid and reliable tool, the
Columbia Suicide Severity Rating Scale.3 This tool can be used for
screening and referral/triage by PCPs and OB/GYNs as well as a more intense
assessment of suicidal ideation and suicidal behavior by BHPs.
While these and other organizations may differ on recommendations of suicide
rating scales, they all reinforce that suicide is preventable and that the
health care system must address it. These organizations also reinforce that
healthy connectedness is a protective factor and set an expectation that health
care providers communicate and collaborate on the care of individuals at risk
for suicide.
The National Suicide Prevention Lifeline, 1-800-273-TALK
(8255), is available for any of your patients who may be at risk.
1Crosby AE, Ortega L, Melanson C. Self-directed Violence
Surveillance: Uniform Definitions and Recommended Data Elements, Version 1.0.
Atlanta (GA): Centers for Disease Control and Prevention, National Center for
Injury Prevention and Control; 2011.
2http://store.samhsa.gov/apps/suicidesafe
3Posner, K., et al. The Columbia-Suicide Severity Rating Scale:
Initial Validity and Internal Consistency Findings From Three Multisite Studies
With Adolescents and Adults, American Journal of Psychiatry, 2011;
168:1266-1277.
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