Brief Suicide Screening in Primary Care Cut Risk by 25%: Family Physician Highlights NIMH Study

Family physician Teresa Lovins, MD, recently spoke with Patient Care^© editors about a study conducted across 19 Kaiser Permanente clinics in Washington State that showed systematic suicide screening and safety planning in primary care settings reduced suicide attempts by 25% within 90 days of a visit. The study, published in the Annals of Internal Medicine,¹ provides compelling evidence for the life-saving role a primary care clinician can play with the support of a targeted, structured program that catches people at risk of self harm and steers them to appropriate resources.

"In my own practice, I’d estimate at least 1 or 2 patients each week have some degree of suicide risk," Lovins said. "We also know that many individuals who die by suicide have seen their primary care physician within the past several months," she added. "That tells us the problem is far more widespread than what we’re recognizing or addressing. So, having research that validates effective screening methods is an important first step in finding these patients and making sure they get the help they need.”

Lovins' experience as a family practitioner and physician owner of Lovin My Health DPC, in Columbus, Indiana, echoes recent research that shows nearly 45% of individuals who die by suicide have visited a primary care provider within a month of their death.² Separate research found that 80% of suicide victims had seen a primary care clinician within the year prior to their death, compared to 25% to 30% who had seen a mental health specialist.^3,4

The study, which Lovins highlights in the short video above, was sponsored by the National Institute of Mental Health.¹ More than 228,000 adults were seen during the suicide care intervention period, with systematic screening for depression, alcohol and drug use, and suicidal ideation. The screener for suicidality was a simple 4-question format, Lovins explained. Individuals with positive screening results were further assessed, and those at risk were connected with care team members for same-day safety planning, short-term counseling, and linkage to specialty services as appropriate.¹

Compared with usual care, integration of this model led to:

• A 14% increase in documented safety planning within two weeks of a primary care visit where suicide risk was identified.
• A 25% reduction in suicide attempts within 90 days of a visit, with rates dropping from 6.0 to 4.5 per 10,000 patient visits.

Although there are no recommendations currently for population-level mental health screening, the study suggests that primary care clinicians need to set a low bar for assessment, collaborative safety planning, and facilitated connections to behavioral health services.

The following transcript has been lightly edited for style and flow.

Patient Care: Would you describe the NIMH study and the findings?

Teresa Lovins, MD: So this is a study that was done by the National Institute of Mental Health. And it looked at how to identify patients who are at risk for suicide in order to get them onto the right treatment course. And it was done through a 4-question screener that primary care doctors or their staff could administer to the patient to help identify those that needed further intervention, who needed further questioning to determine what kind of suicide risk they might really have.

The intervention actually showed that by asking the question, we could reduce the risk of suicide in those patients for the next 3 months by 25% and so it's a matter of asking the question and directing them towards the right care to keep them healthy after they leave the physician's office.

References

1. Richards JA, Curz M, Stewart C, et al. Effectiveness of integrating suicide care in primary care. Secondary analysis of a step-wedge, cluster randomized implementation trial. Ann Intern Med. Published online September 30, 2024. doi:10.7326/M24-0024

2. Stene-Larsen K, Reneflot A. Contact with primary and mental health care prior to suicide: A systematic review of the literature from 2000 to 2017. Scand J Public Health. 2019;47(1):9-17.

3. Walby FA, Myhre MØ, Kildahl AT. Contact With Mental Health Services Prior to Suicide: A Systematic Review and Meta-Analysis. Psychiatr Serv. 2018;69(7):751-759.

4. Harmer B, Rizvi A, Saadabadi. Suicidal ideation. StatPearls [internet]. National Center for Biotechnology Information. Updated April 20, 2024. Accessed August 27, 2025. https://www.ncbi.nlm.nih.gov/books/NBK565877/