Coleman, K. J., Stewart, C., et al. (2025).
Psychiatric services (Washington, D.C.),
Advance online publication.
Abstract
Objective: This study examined receipt of three components (screening, risk assessment, and intervention) of the national Zero Suicide model among patients of various races-ethnicities who were treated in six large health systems.
Methods: The data included outpatient psychiatry and addiction medicine visits (N=4,682,918) during 2019 for patients age 13 and older. Documentation in the electronic health record of administration of the nine-item Patient Health Questionnaire, the Columbia-Suicide Severity Rating Scale, and lethal means counseling and provision of crisis resources (with or without a full Stanley-Brown Safety Plan) were used to define having received suicide screening, risk assessment, and intervention, respectively.
Results: After adjustment for age, sex, and health system, analyses indicated that Black patients were 12%-20% less likely (odds ratio [OR] range 1.12-1.20), and Asian patients were 5%-15% more likely (OR range 1.05-1.15), to be screened for suicidal ideation compared with patients of other races-ethnicities. Compared with White patients, patients of other races-ethnicities were found to be more likely (OR range 1.08-1.24) to receive risk assessment, and Asian and Black patients were found to be 17% (95% CI=1.02-1.35) and 15% (95% CI=1.01-1.32) more likely, respectively, to receive an evidence-based intervention for suicide prevention. American Indian/Alaska Native (AI/AN) patients had the lowest unadjusted rates of receiving an intervention (65.8%).
Conclusions: The adjusted analyses suggested that more focus is needed on population-based screening for suicidal ideation and to improve delivery of evidence-based interventions for suicide prevention among White patients. The descriptive findings suggest that more research is needed to improve intervention delivery to AI/AN patients at risk of suicide.
Highlights
- Black patients were less likely, and Asian patients were more likely, to be screened for suicidal ideation compared with patients of other races-ethnicities.
- White patients were less likely than patients of other races-ethnicities to have risk for suicide assessed after a positive screen for ideation and were less likely than Asian or Black patients to receive an evidence-based intervention for suicide prevention.
- The descriptive findings suggested that improvement is needed on intervention delivery to American Indian/Alaska Native patients at risk of suicide.
- Better strategies are needed for population-based screening and delivery of evidence-based interventions
- for suicide prevention in health systems.
