Suicide Risk Screening in Adult Primary Care

An expert workgroup has released recommendations on a clinical pathway (i.e., care pathway) for suicide risk screening in adult primary care settings.

Evolving from a public meeting hosted by the National Institute of Mental Health in 2017, the workgroup included researchers and practitioners with expertise in suicide prevention and/or primary care. Their aim was to develop a clinical pathway to assist primary care practices in the screening, assessment, and referral of adult patients at risk for suicide.

Based on a review of the scientific literature and supplementary expert opinion, the workgroup developed three documents: (1) an introduction providing an overview of the purpose of the pathway and recommendations for its use, (2) a flowchart outlining the process and decision points for screening and assessing adult patients for suicide risk, and (3) guidance on how to implement the process.

These workgroup recommendations reflect extensive review of the literature and several iterations of expert discussion over five years. The clinical pathway is a potentially useful tool for medical and social service providers in primary care and a variety of other clinical settings and could be the basis for comprehensive suicide prevention training programs. The authors also reference a similar pathway developed for youth.^1,2

The authors acknowledge that the pathway has not been evaluated in a clinical setting and further research is needed to determine its feasibility and usefulness in a clinical setting as well as its effectiveness in preventing suicide. Another limitation is that the workgroup did not include input from patients and others with lived experience.

Ayer, L., Horowitz, L. M., Colpe, L., Lowry, N. J., Ryan, P. C., Boudreaux, E., Little, V., Erban, S., Ramirez-Estrada, S., & Schoenbaum, M. (2022). Clinical pathway for suicide risk screening in adult primary care settings: Special recommendations. Journal of the Academy of Consultation-Liaison Psychiatry, 63(5), 497-510.

1. Brahmbhatt, K., Kurtz, B. P., Afzal, K. I., Giles, L. L., Kowal, E. D., Johnson, K. P., Lanzillo, E., Pao, M., Plioplys, S., Horowitz, L. M., PaCC Workgroup. (2019). Suicide risk screening in pediatric hospitals: Clinical pathways to address a global health crisis. Psychosomatics, 60(1), 1-9. https://doi.org/10.1016/j.psym.2018.09.003
2. Horowitz, L. M., Bridge, J. A., Tipton, M. V., Abernathy, T., Mournet, A. M., Snyder, D. J., Lanzillo, E. C., Powell, D., Schoenbaum, M., Brahmbhatt, K., & Pao, M. (2022). Implementing suicide risk screening in a pediatric primary care setting: From research to practice. Academic Pediatrics, 22(2), 217-226. https://doi.org/10.1016/j.acap.2021.10.012