O`Connor E, Gaynes BN, Burda BU, et al. Screening for and Treatment of Suicide Risk Relevant to Primary Care: A Systematic Review for the U.S. Preventive Services Task Force. Ann Intern Med. 2013 Apr 23. doi: 10.7326/0003-4819-158-10-201305210-00642. (Review) PMID: 23609101
BACKGROUND: In 2009, suicide accounted for 36 897 deaths in the United States.
To review the accuracy of screening instruments and the efficacy and
safety of screening for and treatment of suicide risk in populations and
settings relevant to primary care.
DATA SOURCES: Citations from
MEDLINE, PsycINFO, the Cochrane Central Register of Controlled Trials,
and CINAHL (2002 to 17 July 2012); gray literature; and a surveillance
search of MEDLINE for additional screening trials (July to December
STUDY SELECTION: Fair- or good-quality English-language
studies that assessed the accuracy of screening instruments in primary
care or similar populations and trials of suicide prevention
interventions in primary or mental health care settings.
DATA EXTRACTION: One investigator abstracted data; a second checked the abstraction. Two investigators rated study quality.
SYNTHESIS: Evidence was insufficient to determine the benefits of
screening in primary care populations; very limited evidence identified
no serious harms. Minimal evidence suggested that screening tools can
identify some adults at increased risk for suicide in primary care, but
accuracy was lower in studies of older adults. Minimal evidence limited
to high-risk populations suggested poor performance of screening
instruments in adolescents. Trial evidence showed that psychotherapy
reduced suicide attempts in high-risk adults but not adolescents. Most
trials were insufficiently powered to detect effects on deaths.
Treatment evidence was derived from high-risk rather than
screen-detected populations. Evidence relevant to adolescents, older
adults, and racial or ethnic minorities was limited.
Primary care-feasible screening tools might help to identify some adults
at increased risk for suicide but have limited ability to detect
suicide risk in adolescents. Psychotherapy may reduce suicide attempts
in some high-risk adults, but effective interventions for high-risk
adolescents are not yet proven. PRIMARY FUNDING SOURCE: Agency for
Healthcare Research and Quality.