Annotated Abstracts of Journal Articles
2014, 2nd Quarter
Annotation by Kemuel Philbrick, MD, FAPM
LeFevre ML; U.S. Preventive Services Task Force
Ann Intern Med 2014 May 20; 160(10):719-26
ANNOTATION (Kemuel Philbrick)
The Finding: Although the USPSTF recommends that primary care clinicians should remain attentive to screening patients who are in high-risk groups, such as immediately following dismissal from an emergency department visit for a suicidal act or following a psychiatric hospitalization, there is insufficient evidence of benefit to support routine screening for suicide risk in primary care. The American Academy of Family Physicians and the Canadian Task Force on Preventive Health Care reached similar conclusions. The USPSTF continues to support screening for depression in primary care provided such screening is coupled with adequate resources to ensure accurate diagnosis, treatment, and follow-up. However, the USPSTF concluded there is no clear evidence that screening for suicide risk in asymptomatic primary care patients yields improved health outcomes.
Strengths and Weaknesses: Given that suicide was the 10th leading cause of death in the United States in 2010, this update of the 2004 USPSTF recommendations is timely. Unfortunately, available studies for review were sparse, the accuracy of the screening instruments utilized varied widely, and no two studies used the same instrument.
Relevance: Recent emphases on patient safety and the recognition of the potential adverse effects of depression in select groups of medical and surgical patients has increased the attention given to suicide screening in and out of the hospital. Awareness of the paucity of evidence for benefit from routine screening for suicide risk in primary care patients may enable consultation psychiatrists to inform these efforts such that the energy and work invested is directed toward high-risk individuals where intervention may favourably influence outcome.
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.