Groundbreaking Study Proves Columbia Protocol Predicts Those At Risk For Imminent Suicide

NEW YORK, July 19, 2021 /PRNewswire/ -- Suicide is a global problem, and the number of those taking their own life has increased exponentially over the past quarter-century.  Nearly 800,000 people die by suicide every year, one every 40 seconds.  Suicide does not discriminate – it impacts people of every age, racial, ethnic, socio-economic, gender and geographic group. According to several studies, including those by Blue H.E.L.P. and Ruderman Family Foundation, it kills more police than gunfire and more fire personnel than fire.    

While there are a number of effective, evidence-based interventions that can and have helped individuals at-risk, there is now a singular peer-reviewed screening tool that definitively predicts imminent death by suicide. 

In a historic study recently published in Psychological Medicine, scientists in Sweden found that the Columbia Suicide Severity Risk Scale, also known as the Columbia Protocol, "robustly" predicted death by suicide over one-week, one month, and one-year periods.  The study findings, based on a sample of 18,000 psychiatric emergency patients in Sweden between May 2016 and December 2017, showed that the answers given by patients to the Columbia Protocol's questions, which focus on suicide ideation and methods, accurately pointed to the imminence of their suicide.  

The study authors, led by Dr. Johan Bjurberg of the Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, & Stockholm Health Care Services, and the Department of Psychology, Stanford University, described the fact that while suicide screening is routine practice in psychiatric emergency departments in Sweden, evidence for screening instruments is sparse.  Improved identification for nascent suicide risk is important for suicide prevention. The aim of the study was to evaluate the association between the C-SSRS and subsequent clinical management and suicide within one week, one month and one year from screening.  

The findings noted that both suicidal ideation and behavior were prevalent at screening. In total, 107 patients died by suicide during follow-up. Both C-SSRS Screen Ideation Severity and Behavior Scales were associated with death by suicide within 1-week, 1-month and 1-year follow-up. The optimal cut-off for the ideation severity scale was associated with at least four times the odds of dying by suicide within 1 week (adjusted OR 4.7, 95% confidence)  Bjureberg 2021 - Columbia-suicide_severity_rating_scale_screen_version_initial_screening_for_suicide_risk_in_a_psychiatric_emergency_department.pdf

"I'm so pleased that this study affirms my lifework and further validates the importance of fully incorporating the Columbia Protocol into all suicide ideation and prevention initiatives, whether they are community-based, healthcare settings, schools, organizations, or at the government level," said Dr. Kelly Posner Gerstenhaber. 

Under the leadership of Dr. Posner Gerstenhaber, its principal investigator, Columbia University, the University of Pennsylvania, and the University of Pittsburgh — supported by the National Institute of Mental Health (NIMH) — developed the Columbia Protocol for a 2007 NIMH study of treatments to decrease suicide risk among adolescents with depression.

Based on more than 20 years of scientific study, the screening tool – a series of six plain-language questions that anyone can ask – filled an urgent need for suicide research and prevention: a better way to uniformly and reliably identify people who are at risk. The Columbia Protocol achieved accurate and comparable results by using consistent, well-defined, and science-based terminology. Just as important as its ability to identify who might attempt suicide, it was the first tool to assess the full range of a person's suicidal ideation and behavior, including intensity, frequency, and changes over time. 

Today, with endorsements and recommendations from the World Health Organization, Substance Abuse and Mental Health Services Administration, Action Alliance, Centers for Disease Control, Food and Drug Administration, and other entities in the U.S. and globally, it is used in clinical trials, public settings, and everyday situations, such as in schools, faith communities, hospitals, and the military, in all 50 states and on six continents to identify those in need of help and reduce the suicide rate.

The U.S. Department of Defense said that Columbia Protocol is "nothing short of a miracle" and stated the Dr. Posner Gerstenhaber's "effective model of improving the world will help propel us closer to a world without suicide."  The CDC has noted that the Columbia Protocol is "changing the paradigm in suicide risk assessment in the US and worldwide."  The American Psychiatric Association has compared the Protocol's life-saving impact to "the introduction of antibiotics." James Shelton, the former Deputy Secretary of the U.S. Department of Education, said that, "If implemented to the extent of its capacity across the country, the Columbia has the potential to keep the 64 million children in our schools safe physically and mentally by helping prevent school violence."   And Michael Hogan, former Commissioner of the New York State Office of Mental Health, echoed this sentiment, noting that, "having a proven method to assess suicide risk is a huge step forward in our efforts to save lives."

"It's about saving lives and directing limited resources to the people who actually need them," said Dr. Posner Gerstenhaber, the 2018 recipient of the Secretary of Defense Medal for Exceptional Public Service; founder and director of the Columbia Lighthouse Project, a national suicide prevention initiative and clinical professor of child and adolescent psychiatry at Columbia University's Vagelos College of Physicians and Surgeons. 

Research on the use of the Columbia Protocol has confirmed its reliability and validity for assessing risk. Studies also have supported its use by nonmental health staff, in electronic form, and in non-English language translations.

SOURCE The Columbia Lighthouse Project