Screening for Suicide Risk in Adolescents, Adults, and Older Adults in Primary Care: U.S. Preventive Services Task Force Recommendation Statement

O'Connor E(1), Gaynes BN, Burda BU, Soh C, Whitlock EP.
Ann Intern Med. 2013 May 21;158(10):741-54. 
[Description: Update of the 2004 U.S. Preventive Services Task Force (USPSTF) recommendation on screening for suicide risk.
Methods: The USPSTF reviewed the evidence on the accuracy and reliability of instruments used to screen for increased suicide risk, benefits and harms of screening for increased suicide risk, and benefits and harms of treatments to prevent suicide.
Population: This recommendation applies to adolescents, adults, and older adults in the general population who do not have an identified psychiatric disorder.
Recommendation: The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for suicide risk in adolescents, adults, and older adults in a primary care setting. (I statement)]
BACKGROUND: In 2009, suicide accounted for 36 897 deaths in the United States.
PURPOSE: 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
DATA EXTRACTION: One investigator abstracted data; a second checked the
abstraction. Two investigators rated study quality.
DATA 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 studi
eMinimal 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.
LIMITATION: Treatment evidence was derived from high-risk rather than
screening-detected populations. Evidence relevant to adolescents, older adults,
and racial or ethnic minorities was limited.
CONCLUSION: 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.