Association Between Probable Adult ADHD and Profession in India: A Cross-Sectional Study.

A recent report from the National Center for Health Statistics at the Centers for Disease Control and Prevention found that death from suicide increased by 35% across U.S. populations from 1999 to 2018. It is estimated that for every suicide death there are 25 attempts, suggesting multiple opportunities for prevention. Increasing suicide rates have prompted many national organizations to improve identification and intervention strategies for those at highest risk. For example, the Joint Commission released an official National Patient Safety Goal on suicide prevention to be implemented in all hospital settings by July 2020.In response to multiple agency recommendations regarding suicide prevention, the Suicide Prevention Resource Center was created to address suicide prevention throughout the U.S. As part of their efforts, in partnership with other collaborating national advocacy groups, they created the Zero Suicide Framework specific to health care settings. The Zero Suicide Framework is a flexible set of evidence-based clinical practices and implementation strategies encompassing seven domains (lead, train, identify, engage, treat, transition, improve) that are designed to mitigate suicide risk, enhance protective factors, and close gaps in health care that leave at-risk patients vulnerable. The domains are meant to be used as needed, depending upon the resources of any one health care system, and are designed as a set of recommendations to improve the quality of suicide prevention efforts. One of the key clinical practices of this Framework is “identification” which includes two components: screening for suicidal ideation and assessment of suicide risk including intent and plans. Without identifying those at risk for suicide, there is no opportunity to enact the clinical practices of the framework: engage, treat, and transition. Unfortunately, with few exceptions, screening for mental health conditions in general including suicidal ideation are not standard parts of care in U.S. health settings. Screening rates for depression in U.S. primary care settings are universally low, hovering at less than 5% of patients, generally and rates of systematic screening specifically for suicide are even lower. A few health systems, most notably the Veteran’s Health Administration (VHA), the Department of Defense (DOD), and Henry Ford Health System (HFHS) have implemented robust and systematic suicide screening and risk assessment programs. As a result, the VHA has achieved a suicide risk screening rate of 94.5%, and the U.S. Air Force significantly reduced suicide rates among its members. The “perfect depression care” program at HFHS has resulted in some of the lowest rates of suicide in the nation and has been used as a model program for the Zero Suicide Framework.