Implementing universal suicide screening in a large healthcare system's hospitals: rates of screening, suicide risk, and documentation of subsequent psychiatric care

Standardized general population suicide screening in 23 hospitals in northern California identified 2.2% of screened adults with suicide risk, with 62.4% expressing a plan, intent, or suicidal behaviors, 80.3% having documented co-occurring mental health diagnoses, and 52.5% having documentation of subsequent psychiatric care within the system within 90 days. Lay Summary This study reported outcomes of standardized suicide screening using the Columbia-Suicide Severity Rating Scale among adults in 23 hospitals in a large health system in northern California between 7/1/2019 and 12/31/2020. Out of 595,915 patients seen in hospital inpatient or emergency departments, 84.5% were screened and among them 2.2% had suicide risk, 41.3% of whom had a diagnosis of Major Depressive Disorder. Compared to patients without suicide risk, a higher proportion of patients who screened positive for suicide risk were male, Non-Hispanic White, younger, recently homeless, and had co-occurring mental health diagnoses. Overall, 52.5% of those screening positive for suicide risk had documentation of subsequent psychiatric care within the health system within 90 days and this rate was even higher (73%) for individuals whose screenings indicated the highest risk. These findings reinforce the need for increased screening, and research to determine whether screening leads to improved care and fewer suicides. Implementation of suicide risk screening may improve prevention and facilitate mental health treatment. This study analyzed implementation of universal general population screening using the Columbia-Suicide Severity Rating Scale (C-SSRS) within hospitals. The study included adults seen at 23 hospitals from 7/1/2019-12/31/2020. We describe rates of screening, suicide risk, and documented subsequent psychiatric care (i.e., transfer/discharge to psychiatric acute care, or referral/consultation with system-affiliated behavioral health providers). Patients with suicide risk (including those with Major Depressive Disorder [MDD]) were compared to those without using Wilcoxon rank-sum -tests for continuous variables and chi(2) tests for categorical variables. Results reported are statistically significant at p < 0.05 level. Among 595,915 patients, 84.5% were screened by C-SSRS with 2.2% of them screening positive (37.6% low risk [i.e., ideation only], and 62.4% moderate or high risk [i.e., with a plan, intent, or suicidal behaviors]). Of individuals with suicide risk, 52.5% had documentation of psychiatric care within 90 days. Individuals with suicide risk (vs. without) were male (48.1% vs 43.0%), Non-Hispanic White (55.0% vs 47.8%), younger (mean age 41.0 [SD: 17.7] vs. 49.8 [SD: 20.4]), housing insecure (12.5% vs 2.6%), with mental health diagnoses (80.3% vs 25.1%), including MDD (41.3% vs 6.7%). Universal screening identified 2.2% of screened adults with suicide risk; 62.4% expressed a plan, intent or suicidal behaviors, and 80.3% had mental health diagnoses. Documented subsequent psychiatric care likely underestimates true rates due to care fragmentation. These findings reinforce the need for screening, and research on whether screening leads to improved care and fewer suicides.