Suicide Checklist Spots People at Highest Risk11/08/11
TUESDAY, Nov. 8 (HealthDay News) -- The latest rating scale to
determine a person's risk of committing suicide might be better
than other such scales at spotting people in most urgent need of
help, researchers report.
The Columbia-Suicide Severity Rating Scale (C-SSRS) was
developed eight years ago and is already used by clinicians,
emergency responders and others. The new study, appearing online
Nov. 8 in the
American Journal of Psychiatry, backs its use with new evidence.
Researchers who created the scale weighed its scientific
validity against the Columbia Suicide History Form, on which the
newer scale builds, and the Beck Scale for Suicide Ideation, which
is considered the gold standard of assessment tools, said study
author Kelly Posner, director of the Center for Suicide Risk
Assessment at Columbia University.
A big difference, Posner said, is that the C-SSRS measures a
wider range of potentially suicidal behaviors.
"In the past, people would [only] have asked about suicide attempts," Posner said, adding that "the scale identified a range of behaviors -- preparatory behaviors -- writing a will, buying a gun. Now we're getting at these things. [A person] with just one behavior is eight to 10 times more likely to end their life."
"Suicidal ideation" means talking or thinking about killing yourself. The scale has five degrees of ideation, ranging from "wish to be dead" to "active suicidal ideation with specific plan and intent."
"The Beck scale only looks at ideation and the Columbia History only looks at behavior," while the newer scale rates both, Posner explained. "It more clearly delineates the types of thoughts we need to get at."
Posner said that assessing suicide risk should be part of any
routine medical visit.
"I believe it should be, with 50 percent of people [who commit suicide] seeing their primary care physician within the month before they die," she said. "It's a public health crisis, but a preventable public health crisis. We need to do better at screening and identifying."
The test is easy to incorporate into busy medical practices,
Posner said. "Not only does it take just one or two minutes to
administer, the screening version can be a few questions. It
reduces false positives and it's less burdensome than not doing
anything at all, when you're asking the correct questions."
Health Canada, the New York City fire department and public
school system, the Baltimore police department, the U.S. National
Guard and the Israeli Defense Forces have sought training in using
the C-SSRS or are already using it, Posner noted.
"I get calls from judges hearing cases. They're using it to reduce unnecessary hospitalizations and interventions -- the same way schools are using it to redirect limited resources where they need to go," she said.
To evaluate the C-SSRS, the survey was given during three
studies. One involved 124 adolescents who had attempted suicide and
another involved 237 adults who went to a hospital emergency
department for psychiatric reasons. The third was a trial testing
the effectiveness of a medication for 312 depressed adolescents.
The U.S. National Institutes of Health and the American Foundation
for Suicide Prevention funded the research.
Lanny Berman, executive director of the American Association of
Suicidology, said: "The study is a valuable addition to our
understanding of suicide ideation and behavior. Its findings add
weight to our hope that we can adequately measure,
psychometrically, behaviors that are predictive of untoward
outcomes we seek to prevent.
"This scale helps in accomplishing that with those who inform us of their having suicide ideation," Berman added. "That said, a significant proportion of those who die by suicide deny or do not inform us that they are thinking of suicide before they engage in lethal self-destructive behavior, hence we need better tools to assess risk for suicide without relying on communicated ideation as a starting point for that assessment."
Said Posner: "Some people aren't going to tell you, no matter
what you ask." But, "a majority of people when asked will be
forthcoming and will tell -- the point is we're better identifying
those who will and are at greatest risk."
The U.S. Centers for Disease Control and Prevention has more on
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