Literature review to identify standardized scales for assessing adult suicide risk in the primary health care setting

According to the World Health Organization, suicide has become a public health problem of global dimensions. Forty-five percent of suicide fatalities had consulted with a primary care doctor in the month preceding the event, but no suicide risk assessment had been conducted. Although suicide is an avoidable event, there is no standardized scale for assessment of suicide risk in the primary health care setting, where mental health care competencies vary and decisions are often guided by clinical judgment. A search and review of the best available evidence was carried out to identify scales for assessment of suicide risk for the nonspecialist doctor (i.e., ideally, brief, predictive, and validated). We searched PubMed/MEDLINE, Cochrane, Epistemonikos, and Scholar Google. We also contacted national and international experts on the subject. We retrieved 3 092 documents, of which 2 097 were screened by abstract, resulting in 70 eligible articles. After screening by full text, 20 articles were selected from which four scales were ultimately extracted and analyzed. Our review concludes that there are no suicide risk assessment scales accurate and predictive enough to justify interventions based on their results. Positive predictive values range from 1 to 19%. Of the patients classified as "high risk," only 5% will die by suicide. Half of the patients who commit suicide come from "low-risk" groups. We also discuss 1) the importance of evaluating a patient with suicidal behavior according to socio-demographic variables, history of mental health problems, and stratification within a scale, and 2) possible initial actions in the challenging context of primary care.