A panel of government advisers is sticking with its recommendation that providers screen most adults for major depression, but, to the chagrin of mental health advocates, will not advise broad screening for suicide risk.
The renewed guidance from the U.S. Preventive Services Task Force on Tuesday comes amid what President Biden, government agencies, and doctors’ groups have dubbed a mental health crisis across America. On top of soaring depression and anxiety rates, suicide rates also steadily climbed in recent years. As of 2021, suicide was ninth leading cause of death among most Americans and the second leading cause of death among people 10-14 and 20-34 years old.
Surgeon General Vivek Murthy has called for boosted suicide risk screening in an overall effort to reverse these mental health trends.
“Research suggests that asking patients about thoughts of suicide or self-harm is a simple and effective way to uncover most suicide risk and does not increase a person’s risk of suicidal behavior,” read a 90-page advisory issued in late 2021.
However the task force — a panel of 16 doctors and scientists advising the Centers for Disease Control and Prevention — said in its latest review that there is not sufficient evidence to recommend for or against suicide risk screening. The panel also is not recommending that adults older than 65 are screened for anxiety.
Part of the issue is a lack of clarity around how effective suicide risk screenings and so-called risk scores for patients can be, a trio of mental health experts from the University of Washington wrote in the Journal of the American Medical Association Tuesday regarding the decision.
“The goal of questionnaires and risk scores is not to detect some hypothesized latent state of ‘suicidality,’ but to accurately predict future self-harm or suicide attempt, wrote Gregory Simon, Julie E. Richards, and Ursula Whiteside. And the evidence of that, especially for risk scores, is “sparse,” they argue.
One of the only sources of risk score evaluations is the Veterans Health Administration’s REACH VET program, which uses algorithms to predict risk and prompt outreach. Researchers found that participation in that program resulted in a 5% reduction in documented suicide attempts and fewer ER visits from those patients, but not a reduction in overall suicide or other mortality.
Many doctors still ask about suicidal ideation as part of a depression questionnaire, but it is unclear how broadly that screening tool is used, especially outside of mental health-focused appointments, even though depression can impact outcomes in a range of other diseases.
And while there is substantial evidence that at-risk people respond to psychotherapy and follow-up care, those people generally have to be willing to engage in that care. The University of Washington researchers note that even if a doctor identifies someone at risk for suicidal ideation or action, certain tactics like wellness checks could alienate them further.
The task force pinned a “B” grade to its depression screening recommendation — and its guidance for anxiety screening in people younger than 65 years old — meaning payers are required to cover those services under a provision of the Affordable Care Act. However that power is being fought in court, with plaintiffs in Braidwood v. Becerra arguing that the CDC panel does not have authority because its members are not appointed by the health secretary.
The case is now on appeal before the U.S. Court of Appeals for the 5th Circuit.