Universal Suicide Risk Screening in a Safety-Net Health System: Findings From 5.2 Million Encounters.

OBJECTIVE

The authors aimed to examine whether universal suicide risk screening was associated with increased identification of suicide risk across demographic and clinical subgroups.

METHODS

This retrospective observational study analyzed electronic health record data from 5,219,858 encounters at a safety-net health system (2010-2020). The primary outcome was encounter-level suicide risk identification. Multivariable logistic regression was used to estimate adjusted odds ratios (AORs) comparing the periods before and after implementation of universal screening.

RESULTS

Suicide risk was identified in 0.7% of preimplementation encounters and 3.5% of postimplementation encounters (AOR=5.8, 95% CI=5.7-5.9). Relative increases were greatest among encounters involving older adults, charity or self-pay status, and Black patients and encounters in outpatient settings.

CONCLUSIONS

Universal suicide risk screening substantially increased identification across settings, a finding that supports its use as a scalable strategy for equitable detection.