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An effective treatment plan that supports and manages clients at risk of suicide should be informed by a thorough risk assessment.23 A risk assessment is a direct conversation with a patient about their suicidal thoughts, plans and intent; it is a matter-of-fact empathetic conversation that allows patients to discuss suicide openly.
A suicide risk assessment brings together key information about a patient’s current mental state, any current or previous risk and protective factors, any key stresses contributing to the risk, and a review of current supports. It is the combination of these factors and identified warning signs that contribute to a patient’s overall level of risk for suicide.
GPs should consider completing a thorough risk assessment for any patients they are concerned may be at elevated risk due to their current mental state and/or significant life stresses. Some patients will outline their suicidal thinking quite openly, while others will need encouragement to share these thoughts with their GP. Often a starting point is to say, ‘With all this going on, have you ever felt like life is not worth living – is this something that you have considered recently?’
There are a range of tools that can guide GPs through the completion of a risk assessment. Often the use of these tools helps to collate the information, formulate the assessment information and provide the documentation required for the medical file. One such tool is the Screening Tool for Assessing Risk of Suicide (STARS).24
It should also be noted that at present, a statistically strong and reliable method to usefully distinguish patients with a high risk of suicide has not been developed.
There are several other general mental health assessment tools that might also assist with establishing your patients’ levels of wellbeing:
A self-rated, 12-item tool to screen for anxiety, depression and somatisation in primary care.
K10 anxiety and depression checklist
A simple self-report checklist aiming to measure whether patients have been affected by depression or anxiety in the past four weeks.
Depression Anxiety Stress Scales (DASS)
A 42-item self-report instrument designed to measure the three related negative emotional states of depression, anxiety and tension/stress.
Depression self-report questionnaire (DMI-10 and DMI-18)
Self-report measures for assessing depression in the medically ill.
Antenatal risk questionnaire
A clinician-administered questionnaire, designed to consider specific key risk factors thought to increase the risk of women developing perinatal mental health morbidity (eg postnatal depression or anxiety disorder) and sub-optimal mother infant attachment.
Edinburgh Postnatal Depression Scale (EPDS)
A 10-item self-report measure designed to screen women for symptoms of emotional distress during pregnancy and the postnatal period.
Meta-Analysis of Longitudinal Cohort Studies of Suicide Risk Assessment among Psychiatric Patients: Heterogeneity in Results and Lack of Improvement over Time
Matthew Large, Muthusamy Kaneson, Nicholas Myles, Hannah Myles, Pramudie Gunaratne, Christopher Ryan
Published: June 10, 2016