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Why focus on suicide risk?

  •  Suicide is a leading cause of preventable death in Utah.VIPP An average of 501 Utahns die from suicide, and 3,698 Utahns attempt suicide each year.VIPP According to the CDC, Utah adults have the highest incidence of suicidal thoughts in the U.S. — 6.8% of Utah adults reported having suicidal thoughts during 2008–2009; national average during the same period was 3.7%.CRO
  •  Primary care providers (PCPs) and mental health (MH) providers are positioned to help. A significant portion of patients who died by suicide visited healthcare providers in the year before they died by suicide.APA Screening for suicide could help identify patients at risk and reduce suicide in our community.
  • Many Utahns who died by suicide had an addictive substance in their system. According to the 2012 Utah Toxicology Report, the most common substances found in victims who died by suicide fell into the “other” category (43.9%), which includes OTC drugs and benzodiazepines. Next most common substances were alcohol (33.3%), antidepressants (24%), and opiates (21.3%).UDH Monitoring patients’ drug use and access to substances could help prevent suicides.
  •  Suicide affects more than just the person who attempts or dies by suicide. A 2002 study found that 7% of the U.S. population knew someone who died of suicide during the past 12 months. The death of a loved one by suicide is, in itself, a risk factor for suicideCDC1 and contagion is a real concern.
  •  Suicide strains the economy. Suicide costs the U.S. economy approximately $34.6 billion a year in combined medical and work loss costs; each suicide costs an average of more than $1 million.CDC1

SCREENING WITH THE COLUMBIA-SUICIDE SEVERITY RATING SCALE (C-SSRS)

Appropriate screening may identify patients at increased risk of suicide who need treatment, and psychotherapy can prevent suicides. Intermountain recommends screening adult and pediatric patients per the algorithms in this CPM — and measures providers’ screening practices.
Intermountain uses the Columbia-Suicide Severity Rating Scale (C-SSRS) for several reasons:
  • It provides consistent language to enable tracking and measurement of suicide efforts and patient risk over time.
  • It is well-validated, and it reduces false positives,KAT enabling us to focus on the right patients.
  • It has become a local standard in Utah. The State Office of Education, the Utah Department of Human Services, and others have begun using the C-SSRS.

References

APA     Luoma J, Martin C, and Pearson J. Contact With Mental Health and Primary Care Providers Before Suicide: A Review of the Evidence. Am J Psychiatry 2002; 159:909–916. June 2002. http://ajp.psychiatryonline.org/data/Journals/AJP/3737/909.pdf.
CDC1   Centers for Disease Control and Prevention. Injury Prevention & Control. http://www.cdc.gov/violenceprevention/suicide/consequences.html. Accessed June 20, 2014.
CRO     Crosby AE, Han B, Ortega L, et al. Suicidal Thoughts and Behaviors Among Adults Aged ≥18 Years —United States, 2008-2009. http://www.cdc.gov/mmwr/preview/mmwrhtml/ss6013a1.htm. Accessed December 23, 2013.
KAT      Katzen I, Viguera A, Burke T, et al. Improving Suicide Screening at the Cleveland Clinic through Electronic Self-Reports: PHQ-9 and the Columbia-Suicide Severity Rating Scale (C-SSRS).
UDH     Utah Suicide Toxicology Report. Fiscal Year 2012. http://www.health.utah.gov/vipp/pdf/Suicide/FY2012SuicideToxicologyReport.pdf. Accessed April 14, 2014.
VIPP    Utah Department of Health. Violence & Injury Prevention Program. http://www.health.utah.gov/vipp/suicide/. Accessed June 26, 2013.
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