Implementation and Clinical Utility of Suicide Crisis Syndrome Screening in an Acute Psychiatric Setting: A Prospective Observational Study
C. Lovig, P. Osváth, C. Molnár, F. N. Major, S. Venczák, S. Fekete, T. Tényi, L. Cohen, I. Galynker, V. VörösIntroduction
Suicide is still a major public health challenge with approximately 800,000 deaths annually worldwide. Traditional risk assessments heavily rely on self-reported suicidal ideation and static risk factors, which may be insufficient for detecting imminent suicide risk. Suicide Crisis Syndrome (SCS), defined as a pre-suicidal mental-state characterized by affective and cognitive dysregulation may be novel helpful tool in complex suicide risk assessment.
Objectives
This study aimed to implement SCS screening protocols in an acute psychiatric setting and to evaluate their impact on clinical decision-making and patient pathways.
Methods
A prospective observational study was conducted in a university hospital between January and June, 2024. All patients admitted to the acute inpatient and outpatient psychiatric units were assessed using a three-tier screening model. Patients screened positive for SCS underwent structured diagnostic evaluation using the SCS-C (Suicide Crisis Syndrome Checklist) checklist. The associations between SCS symptoms, clinical decisions (admission vs. outpatient care) and treatment outcomes were analysed.
Results
Of 668 patients screened, SCS positivity showed strong predictive value for inpatient admission. 70% of admitted patients screened positive for SCS, compared to only 30% among outpatients. Core SCS symptoms (entrapment, cognitive dysregulation, and social withdrawal) were most predictive for hospitalization. The A-SCS-C demonstrated excellent psychometric performance (sensitivity: 0.955, specificity: 0.723) in identifying cases confirmed by the SCS-C. A significant decrease in SCS symptom burden was observed during hospitalization, particularly between days 10 and 20, indicating treatment response.
Conclusions
SCS screening provide a valuable framework for detecting acute suicidal states that may be overlooked by conventional assessments. A-SCS-C has high sensitivity and specificity with SCS diagnostic tool. The SCS-C may function as a clinical decision-making support tool, however further longitudinal research is warranted to evaluate long-term outcomes, including readmission and suicide prediction.
Disclosure of Interest
None Declared