SCIENTIFIC
Feasibility of Utilizing a Rapid Screening Tool for Suicide and Major Depressive Disorder in Appalachian Acute Care Settings
AUTHORS :
Melinda Sharon , MPH Emergency Medicine , West Virginia University
Erica Shaver , MD , FACEP Emergency Medicine , West Virginia University
Carmen Burrell , DO Emergency Medicine , West Virginia University
Joseph Minardi , MD Emergency Medicine and Medical Education , West Virginia University
Christopher Kiefer , MD , FACEP Emergency Medicine , West Virginia University
Stephen Davis , PhD Health Policy , Management , and Leadership , West Virginia University
Elyce Biddle , PhD Industrial & Management Systems Engienering , West Virginia University
ABSTRACT
INTRODUCTION Patients who commit suicide will often visit the emergency department ( ED ) shortly before death for reasons other than those related to the suicide . These visits may be a prime opportunity to identify patients with symptoms of major depressive disorder ( MDD ) that contribute to suicidal ideation . This pilot study investigated the feasibility of a recently developed tool , the CAD-MDD-S , a combination of the Computerized Adaptive Diagnostic Screening Tool for Major Depressive Disorder ( CAD- MDD ) and four screening questions from the Columbia-Suicide Severity Rating Scale ( C-SSRS ), to identify patients with suicidal thoughts , intent , plans , and behaviors , and / or MDD .
METHODS CAD-MDD-S was administered to ambulatory adult patients ( 18 + years ) who presented at an academic ED or student health services clinic for non-mental health concerns . The goal was to study the feasibility and efficiency of the screening tool , assessing the potential impact the tool may have in identifying at risk patients in these clinical settings .
RESULTS From August 2015 to November 2016 , 345 patients agreed to complete the screening tool ( 89 % agree rate ), with 76 screening positive for MDD , 13 for risk of suicide , and 7 for both . The median screening time to completion was six minutes , with 87 % of patients taking less than 10 minutes .
CONCLUSIONS This pilot study demonstrated that the administration of the CAD-MDD-S diagnostic screening tool was feasible and efficient in emergency settings , and the time to completion did not present a substantial burden to the patient . Future studies are needed to confirm these findings in other populations with larger samples .
INTRODUCTION
Suicide and depression are costly public health issues ( roughly $ 69 billion and $ 83 billion , respectively ) that affect individuals of all ages and backgrounds . 1 , 2 In 2016 , there were more than 44,000 deaths by suicide , making it the tenth leading cause of death in the United States ( US ). 2 Prior research has shown that over 60 % of those who complete suicide suffered from major depression . 3 , 4 Overall , the risk of suicide in persons with a diagnosis of depression is 20 times higher than in the general population . 4 The Appalachian region , particularly the state of West Virginia ( WV ), is highly affected by the public health issues of depression and suicide . According to the 2014 WV Behavioral Risk Factor Surveillance System Report , approximately 24 % of adults reported feeling depressed , which was significantly higher than the overall US prevalence estimated at 18 %, making WV the fourth most depressed state in the nation . 5
Prior literature has demonstrated that a majority of patients who commit suicide have sought medical care within the past month . 6 , 7 One study reported that 82 % of patients who successfully completed suicide had visited a physician within the preceding six months . 6 Of those patients , 51 % had evidence of depression , but only 38 % of those who completed suicide were diagnosed by their provider with depression . 6 However , only about 5.7 % of emergency department ( ED ) patients admitted to suicidal thoughts when directly asked . 8 Approximately 70 % of those who complete suicide visit an ED shortly before death for a problem not related to mental health concerns or suicide . 9 The Joint Commission recommends screening for suicide risk in the ED , as well as screening all patients during the hospital inpatient admissions process . 10 Although the ED is an optimal location to identify these patients , time constraints and other logistical barriers have previously prohibited screenings from effectively becoming a routine part of patient care .
Since the diagnosis of depression is largely dependent on patient self-report , it is crucial to develop and implement an efficient screening method . 11 The CAD-MDD is a computerized adaptive diagnostic ( CAD ) screening tool that has been shown to increase the sensitivity , while maintaining high levels of specificity , for the diagnosis of MDD when compared to other screening tools . 12 The tool is based on a statistical decision-tree algorithm , and it has been shown to decrease patient and clinician burden . A second instrument , the C-SSRS , is an empirically validated , rapid suicide risk assessment instrument that utilizes up to six questions in its algorithm . 13 The purpose of this pilot study was to demonstrate the feasibility of a rapid , efficient screening tool that combines the CAD and C-SSRS for suicidality and depression in two Appalachian acute care settings .
26 • www . wvsma . org