Screening for Suicide-related Thoughts and Behaviors
In the 2019 VA/DoD Clinical Practice Guideline for the Assessment and Management of Patients at Risk for Suicide (VA/DoD Suicide Risk CPG), there are five recommendations that pertain to screening and evaluation for suicide-related thoughts and behaviors.
In terms of screening, recommendation 1 suggests the use of a validated screening tool to identify individuals at risk for suicide-related behaviors. Recommendation 2 more specifically suggests the use of item 9 of the Patient Health Questionnaire-9 (“Over the last two weeks how often have you been bothered by thoughts that you would be better off dead, or of hurting yourself”) as a universal screening tool to identify suicide risk as a component of a system-wide suicide prevention efforts.
The Assessment and Management of Suicide Risk Work Group, who developed the VA/DoD Suicide Risk CPG, strongly recommends an assessment of risk factors as part of a comprehensive evaluation of suicide risk (recommendation 3). Examples of core risk factors for suicide include but are not limited to: any prior suicide attempt, current suicidal ideation, recent psychosocial stressors, availability of firearms, prior psychiatric hospitalization, and psychiatric conditions or symptoms such as mood or substance use disorders, hopelessness, insomnia, and agitation. Importantly, the VA/DoD suicide CPG provides a recommendation against the use of a single instrument or method for evaluation (recommendation 4) and states there is insufficient evidence to recommend for or against the use of a risk stratification approach to determine the level of suicide risk as an expected standard of care (recommendation 5).
At the same time, recognizing that clinicians may benefit from a better understanding of clinical pathways in the management of patients at risk for suicide, Algorithms A to C included in the VA/DoD Suicide Risk CPG can be used to facilitate clinical decision-making processes. Essential features of each level of risk are accompanied by possible actions for the clinician’s consideration. The VA/DoD Suicide Risk CPG Provider Pocket Guide provides useful information on these algorithms, evidence-based treatment options, components of a crisis response plan, and other interventions that may promote adherence to treatment.