Concordance among clinician, patient and independent interviewer’s identification of suicidality in an adult outpatient sample

Background: Accurate identification of suicidal individuals is a complex process among patients seeking mental health services. The purpose of this multi-method multi-informant study was to examine the concordance in identifying the history of suicide attempts and current suicidal ideation among patients, their clinicians and independent interviewers. Method: A convenience sample of clinicians (N=80) and their adult patients (N=170) who engage in psychotherapy and/or psychopharmacology in community mental health clinics in Israel participated in the study. Patients and clinicians completed a one-item question assessing a lifetime history of suicide attempts (from the Clinical Data Form). Patients also completed the Personality Assessment Inventory to assess current suicidal ideation. An independent interviewer completed a structured diagnostic interview (SCID) including a question assessing current suicidal ideation. Results: Approximately 18% of patients reported ever attempting suicide, while only 9% were reported by treating clinicians. There were no false positives reported by clinicians. Concordance between treating clinician’s and patient’s reports on the patient ever attempting suicide revealed a strong positive correlation (Kappa= .73). We also found a significantly high correlation between the independent interviewer’s and patient’s reports of suicidal ideation (Spearman’s r(32)=.66), indicating moderate to high agreement rates. Conclusion: Our findings suggest that treating clinicians tend to be conservative in their suicide assessment of their patients. As a result, when they do identify a history of a suicide attempt, they tend to be accurate in their report, yet they also risk under-identification. Clinicians may also fail to ask about this sensitive information and some patients may not reveal information about suicidality to their treating clinicians. Given the complexity of the assessment process for suicidality, triangulating information from multiple sources is recommended. Clinicians should conduct a systematic and explicit suicide risk assessment as well as collect patients’ reports using well-validated measures.