Department of Veterans Affairs (VA) and Department of Defense (DoD)
Assessment and Management of Patients at Risk for Suicide
This guideline holds 24 recommendations, 213 references, 17 tables and 1 figure.
Summary
The annual rate of death by suicide among adults in the United States increased over the first two decades of the 21st century. This guideline provides updated evidence-based guidance for the assessment and management of patients at risk for suicide within VA and DoD populations.
Key takeaways
Use a validated screening tool when identifying patients at risk for suicide-related behavior.
Conduct a comprehensive suicide risk assessment exploring multiple domains such as psychiatric symptoms, social determinants, and access to lethal means.
CBT-based psychotherapies are recommended to reduce suicidal ideation and the risk of attempts.
Reducing access to lethal means, such as firearms and medications, reduces suicide risk.
Send periodic caring communications to patients for up to 12 months after hospitalization for suicide risk.
Ketamine infusion may be offered as an adjunctive treatment for short-term reduction in suicidal ideation in patients with MDD.
What is new in this version
Update to the 2019 CPG. Features include: an updated algorithm; review of studies focusing on critical outcomes of suicide attempt and death; addition of 8 new recommendations; 12 replaced, 3 amended, and 1 not changed; stricter application of GRADE methodology; an updated Routine Care for Suicide Prevention section; and an updated Research Priorities section.
Recommendations
Screening and Assessment
There is insufficient evidence to recommend for or against suicide risk screening programs to reduce the risk of suicide or suicide attempts.
Population: Adult patientsWhen: Suicide Risk
When selecting a screening tool, we suggest the use of a validated measure to identify patients at risk for suicide-related behavior (e.g., C-SSRS, PHQ-9, Beck Suicide Intent Scale).
Population: General population and populations at increased riskWhen: Suicide-related behavior
When performing a suicide risk assessment, we suggest including, but not limited to, factors within domains such as self-directed violence, current psychiatric conditions, psychiatric symptoms, social determinants of health, and availability of lethal means.
Population: Adult patientsWhen: Suicide Risk
While risk stratification is an expected component of routine care, there is insufficient evidence to recommend for or against the use of a specific tool or method to determine the level of suicide risk.
Population: Adult patientsWhen: Suicide Risk
Risk Management and Treatment
We suggest cognitive behavioral therapy–based psychotherapy focused on suicide prevention to reduce the risk of suicide attempts in patients with a history of suicidal behavior within the past six months.
Population: Patients with a history of suicidal behavior within the past six monthsWhen: Suicide Risk
We suggest offering cognitive behavioral therapy (including problem solving–based psychotherapies) focused on suicide prevention to reduce suicidal ideation for patients with a history of self-directed violence.
Population: Patients with a history of self-directed violenceWhen: Suicidal Ideation
There is insufficient evidence to recommend for or against completing a crisis response plan or safety planning intervention to reduce the risk of suicide attempts in patients with recent suicidal ideation, a lifetime history of suicide attempts, or both.
Population: Patients with recent suicidal ideation or lifetime history of attemptsWhen: Suicide Risk
There is insufficient evidence to recommend for or against Collaborative Assessment and Management of Suicidality to reduce suicidal ideation.
Population: Adult patientsWhen: Suicidal Ideation
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