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Am J Psychiatry 1995; 152:1601-1607
Copyright © 1995 by American Psychiatric Association
Clinical assessment versus research methods in the assessment of suicidal behavior
KM Malone, K Szanto, EM Corbitt and JJ Mann
NIMH Clinical Research Center for the Study of Suicidal Behavior, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
OBJECTIVE: This study examined how accurately routine inpatient clinical
assessments documented a history of overt suicidal behavior in inpatients
with a diagnosis of major depressive episode. Secondary questions involved
the exploration of possible factors influencing the quality of routine
clinical documentation of suicidal behavior, such as lethality of attempts,
axis II comorbidity, and presence of recent suicidal behavior. METHOD:
Hospital records for 50 patients, known to have a history of suicidal
behavior on the basis of research ratings, were reviewed to assess
reporting of the number of lifetime suicide attempts, suicidal ideation and
planning behavior, most medically lethal suicide attempt, and family
history of suicidal behavior. These measures of suicidal behavior were
compared with a comprehensive research assessment, completed concurrently
and independently. RESULTS: At admission clinicians failed to document a
history of suicidal behavior in 12 of 50 patients identified by research
assessment as depressed and as having attempted suicide. Fewer total
suicide attempts were clinically reported than in research data.
Documentation of suicidal behavior was least accurate in the physician
discharge summary and was most accurate on hospital intake assessment,
which employed a semistructured format for recording clinical information
including suicidal behavior. CONCLUSIONS: A significant degree of past
suicidal behavior is not recorded during routine clinical assessment, and
the use of semistructured screening instruments may improve documentation
and detection of lifetime suicidal behavior. The physician discharge
summary must accurately document suicidal behavior, since it best
identified a high-risk population for out-patient clinicians responsible
for follow-up.
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