CLINICAL-ASSESSMENT VERSUS RESEARCH METHODS IN THE ASSESSMENT OF SUICIDAL-BEHAVIOR

Objective: This study examined how accurately routine inpatient clinic al assessments documented a history of overt suicidal behavior in inpa tients with a diagnosis of major depressive episode. Secondary questio ns involved the exploration of possible factors influencing the qualit y of routine clinical documentation of suicidal behavior, such as leth ality of attempts, axis II comorbidity, and presence of recent suicida l behavior. Method: Hospital records for 50 patients, known to have a history of suicidal behavior on the basis of research ratings, were re viewed to assess reporting of the number of lifetime suicide attempts, suicidal ideation and planning behavior, most medically lethal suicid e attempt, and family history of suicidal behavior. These measures of suicidal behavior were compared with a comprehensive research assessme nt, completed concurrently and independently. Results: At admission cl inicians 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 repor ted than in research data. Documentation of suicidal behavior was leas t accurate in the physician discharge summary and was most accurate on hospital intake assessment, which employed a semistructured format fo r recording clinical information including suicidal behavior. Conclusi ons: A significant degree of past suicidal behavior is not recorded du ring routine clinical assessment, and the use of semistructured screen ing instruments may improve documentation and detection of lifetime su icidal behavior. The physician discharge summary must accurately docum ent suicidal behavior, since it best identifies a high-risk population for outpatient clinicians responsible for follow-up.