Part 3: Screening for Depression
A few simple questions could help doctors stem the suicide epidemic.
There is compelling research showing that an alarming number of emergency room patients have undetected suicidal thoughts. Likewise, research also shows that those with suicidal ideation often visit their primary care doctor prior to a attempting suicide.
This is a large segment of the suicidal population who might be saved if doctors and nurses would simply ask if they’re having suicidal thoughts or are experiencing depression. Yet many do not because they aren’t prepared to treat or refer mentally ill patients.
Universal screening involves primary care clinics and emergency rooms asking everyone who visits whether they are experiencing depression or suicidal thoughts, and if so, following up with brief interventions and providing referrals for treatment.
This idea is endorsed by the National Institute of Mental Health, which has provided millions of dollars in funding for persuading physician groups, health care companies and regulators to support it. Other suicide prevention groups have also pushed for widespread screening.
In one study, researchers found that adding screening in ERs almost doubled the number of patients identified as having suicidal thoughts or who had attempted suicide in the past. This research also found that combining screening with brief telephone counseling after the visit led to 30% fewer suicide attempts after a year of follow-up, compared with standard ER care. By making a safety plan with suicidal patients before discharging them, ER staff also reduced their patients’ risk of suicidal behavior by half.
Safety plans involve making a list of people to call when a suicidal urge comes up, including crisis lines and mental health providers, as well as coming up with coping strategies and limiting access to lethal means like guns, pills, or poisonous substances.
The Suicide Prevention Ministry calls upon faith communities to support this policy change at the grassroots level. Faith communities who participate in our Breaking the Silence program are asked to take action by asking their health care providers to screen for depression and suicide. Because faith communities represent a large percentage of the total population, we believe that listening for screening questions and asking for them can support the efforts of the suicide prevention community. The idea is to support top-down policy endeavors with the convergence of bottom-up personal advocacy.
Physicians have worked with the American Foundation for Suicide Prevention to develop a rapid screening and intervention tool called ICAR2E, which they encourage ERs and health care facilities to adopt voluntarily to help assess and manage suicidal patients. Details of this tool are found on the next page.
The ICAR2E Assessment Tool
Available online at https://www.acep.org/patient-care/iCar2e/
Also available in the emPOC app on Google Play and the App Store.
LISTEN FOR YOUR DOCTOR TO ASK THESE QUESTIONS
IF THEY DO NOT, ASK THEM TO DO SO
Suicide Screening Questions (from the Patient Suicide Safety Screener 3; PSS-3)
Introductory Script: “Now I’m going to ask you some questions that we ask everyone treated here, no matter what problem they are here for. It is part of the hospital’s policy and it helps us to make sure we are not missing anything important.”
1. Over the past 2 weeks, have you felt down, depressed, or hopeless?
___ Yes ___ No ___ Patient unable to complete ___ Patient refused.
If yes, interpretation is “depressed mood”
2. Over the past 2 weeks, have you had thoughts of killing yourself?
___ Yes ___ No ___ Patient unable to complete ___ Patient refused.
If yes, interpretation is “active suicidal ideation”
3. In your lifetime, have you ever attempted to kill yourself?
___ Yes ___ No ___ Patient unable to complete ___ Patient refused.
If YES, ask: When did this happen?
___ Within the past 24 hours (including today)
___ Within the last month (but not today)
___ Between 1 and 6 months ago
___ More than 6 months ago
___ Patient unable to complete.
___ Patient refused.
If within the last 6 months, consider as “recent attempt”
A POSITIVE SCREEN IS DEFINED AS “YES” TO EITHER QUESTION 1 OR 2,
OR A SUICIDE ATTEMPT WITHIN THE LAST 6 MONTHS
Additional Information
Visit https://www.acep.org/patient-care/iCar2e/ for further information on signs indicating possible suicide risk, tips on communicating with patients, additional risk assessments, safety plan and risk reduction steps, and other clinical resources.