Suicide Prevention Among People of Different Races and Ethnicities in Large Health Systems: Implications for Practice

Coleman, K. J., Stewart, C., et al. (2025).

Psychiatric services (Washington, D.C.), 

Advance online publication.

https://doi.org/10.1176/appi.ps.20240477

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.

Google has created a tool that tests for clinical depression

Katherine Ellen Foley
Quartz
Originally posted August 24, 2017

People often delay seeking treatment for mental health conditions like depression. The longer they wait to see their doctors, the worse the condition becomes, making it harder to treat in the future.

In an effort to encourage more patients to seek treatment sooner, Google announced Aug. 23 that it has teamed up with National Alliance on Mental Illness (NAMI), an advocacy group, to create a simple tool for users to assess if they may be depressed. Now, when people in the US search for “clinical depression” on their phones, the typical “knowledge panel”—a container that displays company-vetted information on Google’s search results page—will come with an option to take a quiz that can assess the severity of symptoms. (Google says the quiz results will not be seen by anyone but the quiz-taker.)

Google’s quiz isn’t new. It’s a reskinned version of the 18-year-old PQH-9 (pdf), used by physicians to help diagnose patients with mental illnesses like depression and anxiety. It asks about general interest in activities, eating and sleeping habits, and overall mood. Alone, the PQH-9 won’t give a definitive diagnosis. Doctors use it in conjunction with physical exams to rule out other causes for patients’ symptoms, like a thyroid problem. Google says its incorporation of the PQH-9 test in its search results is not meant as a final diagnosis, but as a tool to inspire people to have conversations with their healthcare providers if they were hesitant before.

The article is here.

E-Health Interventions for Suicide Prevention

Helen Christensen, Philip J. Batterham, and Bridianne O'Dea
Int. J. Environ. Res. Public Health 2014, 11(8), 8193-8212
doi:10.3390/ijerph110808193

Abstract: 

Many people at risk of suicide do not seek help before an attempt, and do not remain connected to health services following an attempt. E-health interventions are now being considered as a means to identify at-risk individuals, offer self-help through web interventions or to deliver proactive interventions in response to individuals’ posts on social media. In this article, we examine research studies which focus on these three aspects of suicide and the internet: the use of online screening for suicide, the effectiveness of e-health interventions aimed to manage suicidal thoughts, and newer studies which aim to proactively intervene when individuals at risk of suicide are identified by their social media postings. We conclude that online screening may have a role, although there is a need for additional robust controlled research to establish whether suicide screening can effectively reduce suicide-related outcomes, and in what settings online screening might be most effective. The effectiveness of Internet interventions may be increased if these interventions are designed to specifically target suicidal thoughts, rather than associated conditions such as depression. The evidence for the use of intervention practices using social media is possible, although validity, feasibility and implementation remains highly uncertain.

The entire research article is here.

Screening Newborns For Disease Can Leave Families In Limbo

By Nell Greenfieldboyce
NPR Health News
Originally posted December 23, 2013

For Matthew and Brianne Wojtesta, it all started about a week after the birth of their daughter Vera. Matthew was picking up his son from kindergarten when he got a phone call.

It was their pediatrician, with some shocking news. Vera had been flagged by New York's newborn screening program as possibly having a potentially deadly disease, and would need to go see a neurologist the next day.

Like every state, New York requires that newborns get a small heel prick so that a few drops of blood can be sent to a lab for testing. The idea is to catch health problems that could cause death or disability without early intervention.

But in recent years, patient advocacy groups have been pushing states to adopt mandatory newborn screening for more and more diseases, including ones that have no easy diagnosis or treatment.

One of those is Krabbe disease, a rare and devastating neurological disorder.

In 2006, New York became the first state to screen for Krabbe, and until recently it was the only state to do so. Screening for this disease is expanding, even though some experts say the treatment available doesn't seem to help affected children as much as was initially hoped — and testing can put some families in a kind of fearful limbo.

The entire story is here.