Department of Veterans Affairs (VA) and Department of Defense (DoD)
Assessment and Management of Patients at Risk for Suicide
Ce document comprend 24 recommandations, 213 références, 17 tableaux et 1 figure.
Contenu en anglais
Synthèse
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.
Messages clés
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.
Nouveautés de cette 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.
Recommandations
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.
Patients concernés: Adult patientsSituation: 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).
Patients concernés: General population and populations at increased riskSituation: 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.
Patients concernés: Adult patientsSituation: 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.
Patients concernés: Adult patientsSituation: 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.
Patients concernés: Patients with a history of suicidal behavior within the past six monthsSituation: 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.
Patients concernés: Patients with a history of self-directed violenceSituation: 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.
Patients concernés: Patients with recent suicidal ideation or lifetime history of attemptsSituation: Suicide Risk
There is insufficient evidence to recommend for or against Collaborative Assessment and Management of Suicidality to reduce suicidal ideation.
Patients concernés: Adult patientsSituation: Suicidal Ideation
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