Are No-Suicide Contracts Effective in Preventing Suicide in Suicidal Patients Seen by Primary Care Physicians?

Kelly, Katherine T.; Knudson, Mark

doi:10.1001/archfami.9.10.1119

Cited by 32 publications

(17 citation statements)

References 8 publications

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“…Although commonly used, the practice of forming nosuicide contracts should be discouraged, as there is no evidence to suggest that such contracts reduce suicide tendencies, but they may instead be used by patients to hide their actual suicidal intent. (32,38) Linking patients to community resources All persons who are depressed or suicidal should be connected to available community resources and crisis helplines. (4,31) Three months later, you met Judy again and saw that she was visibly better.…”

Section: Safety Plansmentioning

confidence: 99%

Depression in primary care: assessing suicide risk

Ng¹,

How²,

Ng³

2017

smedj

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Major depression is a risk factor for suicide, accounting for up to 60% of suicides.(1-4) The literature has shown that a large proportion of patients who died by suicide had made contact with a primary care health provider within the three months preceding their deaths.(5-7) Patients who died by suicide were also more likely to visit their primary care practitioner than a psychiatrist.(6) This suggests that primary care practitioners are in a unique position to identify at-risk individuals and possibly intervene. (6,8,9) Primary care practitioners have been identified as one of the key potential gatekeepers in suicide prevention efforts.(10) Despite this, not all primary care practitioners routinely ask about suicide in depressed patients. WHAT CAN I DO IN MY PRACTICE?There are concerns that enquiring about suicide in patients who are depressed may trigger suicide, but evidence has shown this to be untrue. (12) Acknowledging and discussing suicide may reduce, instead of aggravate, suicidal ideation. Asking about suicide may help primary care physicians to identify high-risk patients who require urgent intervention (such as hospitalisation) and to uncover risk factors, some of which are amenable to intervention. (9) There are numerous tools to screen for suicide risk. One of the more widely used suicide assessment tools is the SAD PERSONS scale. This is a ten-item mnemonic, which was first developed as a tool for medical students and non-psychiatrist physicians to guide suicide risk assessment.(13) The use of the tool has been found to improve identification of persons with suicidal ideation. (14) The letters in the mnemonic represent demographic, behavioural and psychosocial risk factors for suicide (Box 1). Each risk factor that is present is accorded a score of 1 point, for a maximum of 10 points. Patterson et al recommended that: (a) patients with scores of 3-4 should be closely monitored; (b) hospitalisation should be strongly considered for those with scores of 5 and 6; and (c) patients with scores of 7-10 should be hospitalised for further assessment.(13) A systematic review of the performance of the SAD PERSONS scale in the clinical setting concluded that it did not acutely predict suicide behaviour. (15) Nonetheless, it is an easy scale to remember and use in the primary care setting.Information acquired via such assessment tools can add to the overall information obtained during a thorough suicide assessment. However, a systematic review concluded that there was insufficient evidence for the usefulness of suicide risk screening tools and that suicide assessment tools should not replace a thorough suicide assessment. (16) Each risk factor that is present is accorded a score of 1 point, for a maximum of 10 points.Patterson et al (13) recommended:• Close monitoring for patients with scores of 3 to 4• To strongly consider hospitalisation for those with scores of 5 and 6• Hospitalisation for further assessment for patients with scores of 7-10Note: Regardless of the score obtained, overall clinic...

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Section: Safety Plansmentioning

confidence: 99%

Depression in primary care: assessing suicide risk

Ng¹,

How²,

Ng³

2017

smedj

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“…Kroll (2000) found that 41% of clinicians who used no-suicide contracts had patients who died by suicide or made very serious attempts while under contract. Kelly andKnudson (2000, p. 1120) reached a similar conclusion to that suggested here, stating that no empirical evidence supports the effectiveness of no-harm contracts in preventing suicide.…”

Section: Do No-suicide Contracts Work?mentioning

confidence: 53%

The case against no‐suicide contracts: The commitment to treatment statement as a practice alternative

Rudd

Mandrusiak

Joiner³

2005

J Clin Psychol

160

104

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This article reviews the literature on the use of "no-suicide contracts" in clinical practice, including conceptual discussions, patient and clinician surveys, and a few empirical studies on clinical utility. Our primary conclusion is that no-suicide contracts suffer from a broad range of conceptual, practical, and empirical problems. Most significantly, they have no empirical support for their effectiveness in the clinical environment. The authors provide and illustrate the commitment to treatment statement as a practice alternative to the no-suicide contract.

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“…During initial triage, if the patient was deemed safe to wait alone, upon reassessment the triage nurse should confirm that the patient agrees to return to triage if their symptoms worsen. ''No suicide'' contracts are of questionable utility even within the context of a therapeutic relationship (e.g., Farrow, 2002;Kelly and Knudson, 2000) and are not recommended for use in EDs (APA, 2003). Finally, careful documentation of the triage assessment and safety measures in place is of crucial importance (Simpson and Stacy, 2004).…”

Section: Issues Regarding Patient Safetymentioning

confidence: 99%