The article I chose was a study that was completed to assess the use of both the Columbia-Suicide Severity Rating Scale (C-SSRS) and the Patient Health Questionnaire-9 (PHQ-9) simultaneously to identify adolescents at high risk for suicide. The study was a pilot study, the first to assess the use of both screening tools. It offered review of other studies that had been completed on each screening tool alone. The study showed over a 60% rate of identifying adolescents at high risk for suicide and provided immediate interventions. I believe this could become a very useful protocol for any healthcare setting that provides services to adolescents.Nurs446- Journal Club Nurs446 fishbone_template
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This is an topic I use frequently. I work as a mental health nurse and am required to do both the columbia screen and the PHQ-9 on every patient I see and in all it takes maybe 3-5 minutes to complete both screenings. I do feel as though both are good indicators to help evaluate a patients risk of self harm however I do think there are situations that set our patients somewhat up for failure. For example, our hospitals policy states that is someone has a positive columbia or a positive PHQ-9 that they have to be cleared by a provider before they can leave the hospital which sounds amazing in theory but 60% of my patients are post-discharge follow ups for psychiatric hospitalization due to thoughts of self harm or thoughts of harming others. So one of the questions we ask is have you made any attempts to harm or any preparations for an attempt to harm yourself, if yes, was this in the last 3 months. If they answer yes it triggers a positive columbia screening and then what was a 20 minute appointment with me now turns into potentially hours of waiting for a provider to deem them safe to go home even when since discharge they are stating that they are doing better and no longer have thoughts of self harm. Since the introduction of these screens at every visit nursing in my department has seen a large jump in our number of post discharge no shows which I feel may be partly due to this and I feel the progress we make with our patients is to great to no show. That being said I do feel it is a wonderful tool and should be implemented in all medical settings.
I could see how a facility’s protocols regarding the screens could backfire. I wonder if they could gather the data regarding the frequency of no shows compared to the screening and make a quality improvement plan to help decrease them. I do Edinburgh Screens on all pregnant and postpartum women who come into the health department. Our original protocol was that an Edinburgh score of 8 warranted a mental health referral and a score over 10 required an immediate intervention, however this protocol did not take into consideration previous history of depression and if the women were on medications and had to stop the meds due to the pregnancy. I don’t think these screens are as cut and dry as they would like them to be. When I came on board as the Maternal Child Health Coordinator I changed the policy to include more grey areas for referrals and interventions. I think that the screenings are important but we have to have a balance because one size does not fit all. It is the same for adolescent screenings as well.
This is a great topic to discuss and research as mental health is a growing problem throughout all ages of life. In the hospital I work for we use C-SSRS for suicide screening. I have never used the Patient health questionnaire-9 but I believe I have seen it when working in clinics for OBGYN and postpartum mothers. I have never really looked into these questions until after researching about you journal. I think for every well check such as teenager well checks should be reviewing these questionnaires. Parents a lot of the time have no clue there children are suffering from mental illness or depression because of what is happening around them. But what are your thoughts about parents and refusal to even discuss such a thing as suicidal ideation or depression around there children? I know where I work we would question anybody 5 years and older about suicidal ideation. To me at first tried to wrap my head around the thought of asking a 5 year old if they want to harm themselves. To think a 5 year old wants to die is heartbreaking but also information that we as healthcare providers need to know.
I am probably biased when it comes to suicide and depression screenings. This last fall I watched my vibrant, energetic, happy 10 year old do a 180 degree turn. He was diagnosed with depression and he admitted he had thought the world would be a better place without him in it. As a mother my heart was breaking. I took him to a pediatrician that specializes in pediatric Psych and she did both of these screening and a Connors test as well as a genetic test to see how his body metabolizes medications and a blood test to check his thyroid levels. He was ultimately diagnosed with depression, anxiety, ADHD, and Central Hypothyroidism. As I talked with the doctor I learned so much. I did not realize that if a child’s thyroid level is out of whack it causes depression and anxiety. We were able to get him on synthroid and since then his thyroid level have evened out and are normal now and he is not having the anxiety or depression. We did start him on Buspar until his thyroid levels were in normal range. I think that every child should be screened. As parents we never want to believe that our child is the “one” with a mental illness but by not accepting the possibility we do a disservice to our children. I felt comfortable with our doctor and her decisions. She really spent a lot of time with my son and then with both of us. She was not quick to medicate until she had all of the information and I felt better knowing that we were starting my son on medications that worked for his body instead of trying one for 4 wks then changing when it didn’t work. His ADHD meds and the Buspar are both metabolized correctly by his body so we haven’t had to change. Anyway, maybe I got off topic. As for the parents that maybe refuse, I think we could offer education to them on the prevalence of youth suicide. I know I didn’t give it too much though until last fall, but now it is something that is close to my heart and I try to advocate for youth mental health because living in rural Kansas, there are not many resources. We drive 100 miles round trip to see his doctor. So my hope is that by educating and raising awareness we can start to screen more youth and get more services readily available.
As I was reading your journal topic I realized that this topic specifically hits home for me. I work on a military base and we utilize the Columbia Screening and the PHQ-9 on every patient if they “qualify”. We ask everyone about if they are feeling homicidal or suicidal though. It is so dishearting sometimes to see some of the soldiers slip through the cracks. As an MTF, we have plenty of resources to treat these soldiers however it just depends on the severity if they get a long inpatient treatment. I honestly think as a health care worker we can do more for our soldiers than what we are currently doing. Most of the decisions are deferred to the command depending on what they have going on for treatment. A lot of our patient’s get outpatient appointments which sometimes I don’t feel that it is acceptable. As far as the screening goes I think both those screening techniques work well to identify who really needs help and who would benefit from an outpatient appointment. Below is some staggering results regarding suicide in military members.
Suicide in the Military. (n.d.). Retrieved July 11, 2020, from https://deploymentpsych.org/disorders/suicide-main
If you read my reply to the post above it will tell you why youth screenings are so close to my heart, but I am a Marine wife. My husband served for 13 years and my little brother is also a Marine who served for 8 years as a Scout Sniper. I saw first hand the changes in my husband from deployments and agree that there is not enough access for our veterans. My brother’s girlfriend is actually a Psychologist and works for the Palo Alto VA so she had my brother on lock as soon as he came back and made him go talk to someone after every deployment. I do understand how it is difficult for veterans to open up and talk about things with someone other than a brother in arms. My husband has never talked to me about his deployments and my brother is the same way, but I have watched my husband and brother open up to each other. My husband described it really well to me one time by saying when you are deployed you don’t have time to process things, especially death so you push it aside because there is still a job to do, so when you come home and are having a fight with your wife, it is not a big deal to you and you just push it aside, but eventually it bites you in the butt, or you end up blowing up. I just want to say thank you for caring for our veterans, as a spouse I appreciate the work you do. I also agree that we should be screening everyone.
Great post, Suicide is such an important topic to be addressed. This tool seems like it is a good tool to use. A website I was reading discusses that there are several versions of the C-SSRS tool available but the actual Risk Assessment should be followed exactly and should not be altered. It is designed to determine a person’s immediate risk and is used mostly in acute care settings (Lifeline, n.d.). I think that this appears to be a great tool to use and according to the study you researched at greater than 60% accuracy it seems that it is a very appropriate tool to use making sure that you are following it correctly.
Reference:
(n.d.). Lifeline. https://suicidepreventionlifeline.org/wp-content/uploads/2016/09/Suicide-Risk-Assessment-C-SSRS-Lifeline-Version-2014.pdf