(158) Comparison of Suicide Risk Identification in Adult Healthcare Encounters With and Without Universal Screening: Analysis of Age Group and Reason for Encounter

‎Background/Significance: Suicide is a public health concern requiring accurate screening and risk detection. ‎The Joint Commission's National Patient Safety Goal (NPSG 15.01.01) requires suicide risk screening for patients in ‎psychiatric care settings and patients in non-psychiatric settings with behavioral complaints. Suicide decedents often ‎have healthcare encounters for non-psychiatric care just prior to their death, suggesting a missed opportunity for ‎intervention (Ahmedani, 2014). This is especially true for adults over 84 who have the highest rates of suicide and ‎often visit primary care physicians in the year before suicide (Raue, 2014). To improve risk detection, Parkland Health ‎implemented universal suicide risk screening in the emergency department, inpatient units, and primary care clinics. ‎This study compares rates of adult risk identification pre- and post-implementation by age group to examine ‎opportunities for improved suicide prevention.‎

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Methods: Suicide risk screening, demographic, and clinical data were extracted from the electronic health ‎record. Patients were grouped by developmental age (Young Adulthood 18-35; Middle Adulthood 36-64; Later ‎Adulthood 65-84; and Oldest Old 85+), and rates of positive suicide risk were compared from five years prior to ‎program implementation (2010-2015; N = 2,793,005) to six years post (2015-2021; N = 3,656,555). The odds ratio (OR) is ‎a measure of association between the program implementation and positive suicide risk identification. The p-values ‎were calculated using a contingency table between the cohorts, with a corresponding chi-squared test. A Bonferroni ‎correction was applied to account for multiple comparisons. This study was determined to be exempt by the ‎Institutional Review Board.‎

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Results: The odds of a positive suicide risk screen increased by 12.26 times among non-psychiatric encounters ‎and by 9.39 in psychiatric encounters. Positive screens more than doubled among non-psychiatric middle adulthood ‎patients. The percentage of post-positive screens in later adulthood increased across all non-suicide encounters. ‎Middle Adults presenting for psychiatric complaints consistently had the highest odds of positive screens. However, ‎Later Adults have the highest odds of overall positive screens when reasons for encounter are combined (OR = 8.64, p ‎‎ < .001) compared to all other developmental age groups. Non-behavioral encounters represented the highest odds of ‎positive risk identification in later adults compared to all other encounter reasons in other age groups.‎

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Discussion: This longitudinal quality improvement program significantly increased suicide risk identification, ‎highlighting the utility of universal screening protocols regardless of chief complaint. Specifically, implementing ‎universal screening in non-psychiatric encounters yielded the highest overall risk identification in the overlooked later ‎adult population aged 65-84 (OR = 17.02, p < .001).‎

‎Conclusion/Implications: Universal screening significantly increased identification of suicide risk in healthcare ‎encounters, especially those in non-psychiatric settings. Our results underscore the potential benefit of screening in all ‎healthcare encounters, as 78,448 positive screens were for chief complaints that do not require standardized ‎screening.‎

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References: ‎
‎1. Ahmedani BK, Simon GE, Stewart C, et al. Health care contacts in the year before suicide death. J Gen Intern Med. ‎‎2014;29(6):870-877. doi:10.1007/s11606-014-2767-3‎
‎2. Raue PJ, Ghesquiere AR, Bruce ML. Suicide risk in primary care: identification and management in older adults. Curr ‎Psychiatry Rep. 2014;16(9):466. doi:10.1007/s11920-014-0466-8‎