Development and pilot study of simple suicide risk rulers for use in the emergency department

UMMS Affiliation

Department of Emergency Medicine

Publication Date


Document Type



Emergency Medicine | Health Services Administration | Health Services Research | Mental and Social Health | Psychiatry and Psychology


BACKGROUND: Many patients treated in the emergency department (ED) for non-psychiatric complaints have elevated suicide risk. Universal screening can detect occult suicide risk, but gold standard risk measurement tools, such as the Beck Scale for Suicidal Ideation (BSS), are too long and cumbersome for ED use.

OBJECTIVE: To test the performance of seven novel 0- to 10-point suicide risk "rulers" against the BSS.

METHOD: 399 patients from three EDs completed seven novel risk rulers, traditional binary screening items, and the BSS. Using BSS criterion references, we tested the diagnostic performance of each risk ruler and examined correlations between the rulers and BSS scores.

RESULTS: By varying thresholds on the risk rulers, high levels of sensitivity and specificity were obtained. A threshold of 3 on the "sadness" ruler gave 89% sensitivity for the BSS criterion reference, and a threshold of 1 on the "wish to be dead" ruler provided 94-97% specificity.

CONCLUSION: Our novel risk rulers may be an efficient way to detect risk and triage potentially suicidal patients, showing good concurrent validity with the BSS. Clinicians can obtain high sensitivity and high specificity using just two rulers. Further research should examine the rulers' ability to predict independent clinician risk ratings and prospective suicidal behavior.


Emergency department, Risk, Screening, Suicide

DOI of Published Version



Gen Hosp Psychiatry. 2018 Aug 9. pii: S0163-8343(18)30052-5. doi: 10.1016/j.genhosppsych.2018.08.004. [Epub ahead of print] Link to article on publisher's site

Journal/Book/Conference Title

General hospital psychiatry

Related Resources

Link to Article in PubMed

PubMed ID