New data on suicide risk assessment in the emergency department reveal the need for new approaches in research and clinical practice

The Brief Suicide Cognitions Scale: Development and Clinical Application

“…In light of these findings, researchers have tested and validated shortened versions of the scale that may be more practical for use in clinical settings as a screening and/or assessment tool (26,29). Taken together, these studies suggest the SCS assesses aspects of suicidality that are distinct from suicidal ideation, plans, intent and urges, consistent with recent calls for new approaches (30), and arguably the most important contribution of the B-SCS.…”

Recognizing flawed assumptions in suicide risk assessment research and clinical practice

“…Their recommendation is bolstered substantially by the large sample sizes of both studies cited ( N = 18 684 and N = 92 643), coupled with 30-day and 365-day after ED-visit suicide outcome data. In addition to the recommendation offered by Simpson et al ( 2021 ), these findings reveal a broader problem for research and clinical practice focused on suicide risk assessment, that is, a potential failure to recognize flawed or unacknowledged underlying assumptions driving the effort in some clinical arenas, particularly healthcare and clinical settings.…”

“…Simpson, Loh, and Goans ( 2021 ) make an excellent point about the recent C-SSRS Screener findings, calling for new approaches in research and clinical practice targeting suicide risk assessment in light of poor predictive value estimates in real-world clinical settings like emergency departments. Their recommendation is bolstered substantially by the large sample sizes of both studies cited ( N = 18 684 and N = 92 643), coupled with 30-day and 365-day after ED-visit suicide outcome data.…”

Finding Effective and Efficient Ways to Integrate Research Advances Into the Clinical Suicide Risk Assessment Interview

“…Screening tools and standard assessment instruments are only a starting point and one piece of information in a comprehensive suicide risk assessment process. Clinical decisions should not be made based solely on the scores obtained from these instruments, however, as considerable evidence shows that suicide risk screening tools have very poor accuracy and predictive value (2,3). The accuracy of standardized instruments is reduced in part by the unwillingness (or even inability) of some individuals to reveal risk through direct and specific questioning (15), along with the observed temporal dynamics of suicidal thinking (4), a phenomenon that existing assessment tools are yet to meaningfully capture and measure.…”

“…The last several decades have witnessed a sharp, positive trajectory in suicide-related research, much of it with direct and important implications for day-to-day clinical practice (1). In particular, five identifiable domains of research are of importance for practicing clinicians, including recent work demonstrating: (a) the limited predictive value of traditional suicide risk scales (e.g., the Columbia Suicide Severity Rating Scale, C-SSRS) in real-world healthcare settings (2,3), (b) the temporal dynamics and natural variability of suicidal ideation and motivation to die across clinical and non-clinical populations [e.g., (4-7)], (c) the importance of assessing constructs other than suicidal ideation that are convincingly linked to enduring risk or chronic vulnerability for suicide [e.g., (8)(9)(10)], (d) the importance of understanding and assessing the potential for poor individual adherence and cooperation with clinical care (8), and (e) the elegant utility of patients' expressed wish to live and wish to die, coupled with reasons for living and reasons for dying (11)(12)(13). Regardless of the clinician's preferred theoretical perspective or approach, findings across all five of these domains can easily and efficiently be integrated into the suicide risk assessment interview, with straightforward questions that carry very little time-burden for the clinician and/or patient, while potentially capturing data essential to efforts to accurately understand, assess and respond to suicide risk.…”