SANTA ANA, Calif. -- A study published in the May edition of Crisis magazine, the international journal of crisis intervention and suicide prevention, reports that mental health professionals can better detect suicide risk in their patients if they are alerted to early 'warning signs' from patient health questionnaires.

The study, involving 43,000 patients and 3,500 mental health professionals, showed clinicians missed early suicide "warning signs" in adult patients 57 percent of the time, compared with reports filed by patients themselves. The rate dropped to 39 percent when clinicians were made aware of the differences between their assessment and the patient's responses on the questionnaire. The study was conducted by G.S. (Jeb) Brown, PhD of the Center for Clinical Informatics in Salt Lake City, Utah, and Edward R. Jones, PhD of PacifiCare Behavioral Health (PBH), a managed behavioral healthcare organization (MBHO) based in Santa Ana, Calif., during a three-year period from through .

During to adult patients were flagged for review by a PBH Care Manager when they self-reported frequent thoughts of suicide on the questionnaire provided by PBH. In more than half (57 percent) of these cases, the clinician assessed the patient as having no suicidal ideation. In , the difference between patient and clinician assessments was reduced to 39 percent, an 18 percent decline, based in part on more effectively getting the patient self-report information into the clinician's hands.

In children and adolescents the results were nearly as significant. In , clinicians and patients differed in their assessments 38 percent of the time. In , the rate declined to 30 percent.

The combined 'error rate' (the difference between clinician and patient assessments) dropped from 52 percent to 37 percent among adult and youth patients. This represents a statistical improvement in risk assessment of 29 percent.

"Suicide is the ultimate human tragedy," said the study's co-author Dr. Jones, vice president of clinical operations at PBH. "It has a profound impact on loved ones, family and friends of the victim. For clinicians, it can be challenging to assess patients with suicidal thoughts. But tools are available today to assist mental health professionals in detecting these risks early in treatment before suicidal behavior emerges.

"Listening to the patient is the essence of good psychotherapy," he stressed. "Tools like those in our study helped clinicians listen more clearly and supported the patient's need for additional or alternative treatment."

The backbone of the study was PBH's Life Status Questionnaire (LSQ), a 30-question patient self-evaluation instrument, (a similar tool was also utilized for young children and adolescents, called the YLSQ). Both are part of the company's innovative ALERT (Algorithms for Effective Reporting and Treatment) system, an outcomes management system that provides real-time treatment guidance for more than 4 million PBH members throughout the United States.

In addition to the LSQ, PBH asks clinicians to complete one-page assessment forms during the patient's treatment. If a patient's assessment conflicts significantly with his or her therapist's, the clinician is contacted to better understand the discrepancy and revise or extend the patient's treatment plan as needed.

While the authors maintain that patients who acknowledge frequent thoughts of suicide do not all have a high probability of suicide completion, early intervention is the best way to prevent life-threatening behavior. In the study, PBH analyzed the connection between high frequency of suicidal ideation and high levels of depression, self-blame and hopelessness. Analysis showed that there is a significantly strong connection between those feelings and frequent thoughts of suicide. These patients often require more intensive services, making it all the more important to identify "at-risk" patients early and to provide effective treatments.

"Patients with frequent suicidal ideation may follow an unfortunate path of worsening depression and an inability to function, resulting in hospitalization," Jones added. "The goal is to work with mental health professionals to help them better identify these patients early in treatment and ensure they get the appropriate type and amount of care."

PBH uses the ALERT system not only to identify "at-risk" patients in terms of suicide risk, but also to identify patients at risk of chemical dependency and premature treatment termination. To date, the ALERT system has produced significant results in terms of identifying undetected substance abuse and suicide risk and has helped to improve outcomes for severely impaired members.

Source: PacifiCare Behavioral Health