Screening through Primary Care Providers to Prevent Suicide

A common myth about suicide is that it happens without warning, but the reality is that there are often warning signs. These signs can be hard for a loved one to see, especially if they don’t know anything is wrong in the first place. However, a trained professional can easily pick up on the signs—if they ask the right questions.

Interestingly, a study in the American Journal of Psychiatry revealed that about 45% of people who die by suicide see their primary care providers within a month of their death. If there were a system in place to screen for suicidal thoughts, it could potentially save lives.

How to Screen Patients

There are two broad screening models. Universal screening is administered to every patient, regardless of medical history or risk factors. Targeted screening focuses on individuals who have a history of suicidal thoughts or mental illness, or who possess risk factors for suicide.

There are also many different types of screening tests based on these two models. These vary in length and content. Universal screenings are shorter tests that ask more general questions. Targeted screening should go more in-depth and explicitly ask about suicidal ideation to give an accurate idea of suicide risk.

The Argument for Universal Screening

Universal screening can be a lifesaving tool when practiced at most doctors’ offices. Although some may argue it is not necessary for the majority of patients, consider the fact that approximately 54% of people who have died by suicide did not have a diagnosed mental health condition. Suicidal thoughts can occur in any individual and for a number of reasons. Financial issues, relationship conflicts, legal troubles and other stressors can lead to suicidal ideation.

Universal screening can be a safety net for individuals who are struggling but are not sure where to turn for help. Some may feel more comfortable talking with a trusted doctor than reaching out to a mental health treatment program themselves. Once a primary care provider is aware that a person is having suicidal thoughts, they can provide referrals and resources.

Using Suicide Risk Factors to Inform Targeted Screening

It’s important for doctors to be aware of suicide risk factors, and these can be used to determine which individuals may benefit from more targeted, in-depth screening. Here are some of the known risk factors that have been identified by the National Institute of Mental Health(NIMH) and the Centers for Disease Control and Prevention (CDC).

• A medical history that includes mental illness or substance use disorders, either in the individual or their family
• A history of abusing alcohol or drugs
• Past suicide attempts, suicidal thoughts, or suicidal ideation
• Social isolation or loneliness
• The presence of firearms in the home
• Past physical or sexual abuse
• Chronic pain or a chronic illness
• Major life changes such as divorce or death

People who have one or more of these risk factors would be a good candidate for a targeted screening at least once a year, keeping in mind the fact that these are not definitive indicators that the individual is experiencing suicidal thoughts. On the same note, individuals who do not have any of these risk factors may have suicidal thoughts or ideation. That is why universal screening is crucial.

Providing Mental Health Resources to All Patients

Doctors should also start providing mental health resources such as the National Suicide Prevention Lifeline (1-800-273-TALK) and the Crisis Text Line (text “HOME” to 741-741) to all patients. This ensures that even if patients do not disclose suicidal thoughts on a screening test, they will still be connected with resources that they can reach out to in a crisis.

Suicide prevention is an effort that needs to be advanced at a community level. Primary care providers are in the perfect position to identify potential suicide risk and provide resources to those who might not know where to turn to for help.

Jodi Jaspan is a licensed professional counselor and serves as the director of business development for The Light Program, an outpatient mental health treatment program with several locations in eastern Pennsylvania.