A systematic review of brief screeners for suicidal behaviour in primary care

Abstract

Background As primary contacts, general practitioners can play a pivotal role in identifying suicidal behaviour in their patients. Therefore, actively screening patients at risk should be an integral part of primary care services. We summarized the available studies reporting diagnostic accuracy of short screening instruments for suicidal behaviour in primary care or the general population in a narrative synthesis. A brief instrument could improve the identification of vulnerable patients and their subsequent referral to mental health specialist. Methods: The following databases MEDLINE, EMBASE, PsychINFO, PSYNDEX, and Cochrane Library were searched in January 2019 without any time constraints. Risk of bias and applicability concerns were assessed using the QUADAS-2 tool. The certainty of evidence was rated via GRADEpro. The authors followed the PRISMA extensions for Diagnostic Test Accuracy Studies. Results Six relevant studies fulfilled all criteria and were included. Each index test was only assessed in a single study. The studies each used different reference standards. Target conditions defined across the different studies were suicidal ideation, suicide plan, suicide attempt, and suicidal behaviour in general. The diagnostic accuracy measurements sensitivity and specificity had a wide range (sensitivity: 26% - 100%, specificity: 64% - 99%). Risk of bias was rated moderate and concerns regarding applicability acceptable. A required sensitivity of at least 80% and specificity of 50% with a moderate to high GRADE rating was achieved by six of nine index tests. Conclusions Overall, only a few studies assessed screening instruments for suicidal behaviour in primary care or the general population. The identified studies were heterogeneous regarding sample size, index test, and reference standard. Since each index test was only evaluated in one study, their interpretability is limited. No uniform gold standard was found, as the studies identified used different reference standards. Although there are other promising short questionnaires, the majority has not yet been evaluated in primary care setting or the general population with regard to their diagnostic accuracy. A final assessment should always be based on the clinical judgement of the attending physician. Registration The study protocol was registered at PROSPERO (ID: CRD42019122173).

Identifying and Managing Suicidality in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome

“…No intervention is necessary (*Note: Clinical judgment can always override a negative screen). These low PPVs are in-line with other suicide assessment instruments [73] and may not be as alarming as they first seem. Predictive values are substantially influenced by the prevalence or absence of a condition in a population.…”