Assessing Outcomes of Health System Suicide Risk Screening Programs
Michael Schoenbaum, Ph.D.
Division of Services and Intervention Research, and NIMH Suicide Research Team
The rising rates of suicide deaths and non-fatal suicide behaviors in the US are pressing public health challenges. Nearly half of suicide decedents visit emergency care in the year before death, around one-fifth in the month before death; and approximately 80% of suicide decedents have some type of health care encounter in the year before death. These rates underscore the importance and value of improving identification and treatment of suicide risk in emergency departments and other health care settings. In recent years, some US health systems have begun to expand suicide risk screening, up to and including screening in every patient-encounter. These programs have yielded information on rates of case-finding in various care settings and patient groups, but much less is known about key patient outcomes beyond the screening itself, such as fatal and non-fatal suicide behaviors.
The goal of this initiative is to support assessment of suicide-related patient outcomes in health systems that implement wider suicide risk screening in their care settings. Such assessment involves health systems linking data they hold on their patient panels/populations, including suicide risk screening scores/results, to mortality data and to data on subsequent health care. Such linked data will enable analyses and reporting of key outcomes among patients served by health systems that have implemented wider suicide risk screening, and comparing these with the outcomes of patients served in prior periods and/or in settings with less extensive suicide risk screening.
A growing number of health systems in the US have initiatives to expand suicide risk screening. Some of these have reported on aspects of this work, such as the development, implementation and operation of their suicide risk screening program. However, limited data are available on health outcomes associated with such programs; nor on trajectories of health care use and costs for patients identified with different suicide risk screening scores. The former provides information on the clinical and public health benefits of suicide risk screening programs, while the latter provides information on the possible workflow and financial effects of such programs. This initiative aims to support linkage and analyses of data on health, health care and mortality of patient panels/populations, in relation to health system implementation of suicide risk screening programs, and in relation to patients’ suicide risk screening results. Analyses of interest include, but are not necessarily limited to:
- The fraction of patients in particular care settings who were identified with suicide risk, before and after implementation of a suicide risk screening program.
- Patterns of suicide death and other relevant types of mortality over particular periods of follow-up after an index clinical encounter, for patient groups defined by care setting and identified suicide risk.
- Patterns of non-fatal suicide events, and other relevant types of injury (e.g., unintentional overdoses, non-overdose unintentional injury) over particular periods of follow-up after an index clinical encounter, for patient groups defined by care setting and identified suicide risk.
- Patterns of emergency department and hospital use and costs over particular periods of follow-up after an index clinical encounter, for patient groups defined by care setting and identified suicide risk.
Findings would inform quality improvement programs focused on suicide prevention by health systems across the range of current suicide risk screening practices, from those that conduct minimal screening to those with more comprehensive or universal screening programs; inform possible revision of health care accreditation standards and other policies that could affect use of evidence-based suicide prevention practices; and identify key areas for future research to increase the effectiveness and efficiency of suicide prevention practices.