Category: Suicide and Self-Injury
Suicide is a significant public health issue in the US. Despite national and international prioritization since 1996, little definitive progress has been made in terms of identification and intervention in cases of elevated suicide risk. Recent suicide prevention research suggests that 40% of those who died by suicide attended an emergency department within a year of death. Therefore, universal suicide risk screening in emergency departments could prove a vital component to a national suicide prevention strategy. Parkland Health and Hospital System (PHHS) implemented the first universal suicide risk screening program in the US; the sample consisted of patients over 18 years of age (N=333,855, Mage=42.7, 32% male) screened as part of routine clinical care from May 4th, 2015, through November 3rd, 2015. The sample was 13% non-Hispanic White, 27% non-Hispanic Black, and 57% Hispanic. The Parkland Algorithm for Suicide Screening (PASS) is part of a clinical decision support system for responses to Columbia – Suicide Severity Rating Scale Clinical Practice Screener (C-SSRS) items, leading to an automated clinical response via three suicide risk stratification levels: no action for no risk identified, psychiatric social worker assessment for moderate risk, and psychiatrist/psychologist interview for high risk. The present study used receiver operating characteristic (ROC) curves to evaluate the ability of PASS-weighted C-SSRS scores to predict psychiatric vs. non-psychiatric disposition. The analysis yielded an area under the curve of .78, indicating a large degree of non-overlap in screener scores between disposition categories. In addition, the results supported the lower cutoff and suggested increasing the higher cutoff would best balance the algorithm’s efficiency and optimize cost. These results show the universal suicide screening program at PHHS to be an effective means of clinical decision support. Implications, limitations, and future directions will be discussed.