40280382-5a66-eab9-015a-704d816c0247Child and Adolescent Major Depressive Disorder (MDD): Suicide Risk AssessmentCMS177177848d09de-7e6b-43c4-bedd-5a2957ccffe36.0.0000000010100001231PCPI(R) Foundation (PCPI[R])American Medical Association (AMA)PCPI(R) Foundation (PCPI[R])National Quality ForumPercentage of patient visits for those patients aged 6 through 17 years with a
diagnosis of major depressive disorder with an assessment for suicide riskCopyright 2017 PCPI(R) Foundation and American Medical Association. All Rights Reserved.The Measures are not clinical guidelines, do not establish a standard of medical care, and have not been tested for all potential applications.
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Due to technical limitations, registered trademarks are indicated by (R) or [R].ProportionProcessNoneNoneNoneResearch has shown that patients with major depressive disorder are at a high risk for suicide, which makes this assessment an important aspect of care that should be assessed at each visit. According to a study analyzing the quality of health care in the United States, only about 25.8% of patients with depression had documentation of the presence or absence of suicidal ideation during the first or second diagnostic visit. 76.11% of those patients who have suicidality were asked if they have specific plans to carry out suicide. A 2003 study reviewed medical records to assess the degree to which providers adhered to depression guidelines in a VA primary care setting. Providers documented exploration for suicidal ideation in 57% of the records.The evaluation must include assessment for the presence of harm to self or others (MS). (AACAP, 2007)
Suicidal behavior exists along a continuum from passive thoughts of death to a clearly developed plan and intent to carry out that plan. Because depression is closely associated with suicidal thoughts and behavior, it is imperative to evaluate these symptoms at the initial and subsequent assessments. For this purpose, low burden tools to track suicidal ideation and behavior such as the Columbia-Suicidal Severity Rating Scale can be used. Also, it is crucial to evaluate the risk (eg, age, sex, stressors, comorbid conditions, hopelessness, impulsivity) and protective factors (eg, religious belief, concern not to hurt family) that might influence the desire to attempt suicide. The risk for suicidal behavior increases if there is a history of suicide attempts, comorbid psychiatric disorders (eg, disruptive disorders, substance abuse), impulsivity and aggression, availability of lethal agents (eg, firearms), exposure to negative events (eg, physical or sexual abuse, violence), and a family history of suicidal behavior. (AACAP, 2007)
A careful and ongoing evaluation of suicide risk is necessary for all patients with major depressive disorder (Category I). Such an assessment includes specific inquiry about suicidal thoughts, intent, plans, means, and behaviors; identification of specific psychiatric symptoms (eg, psychosis, severe anxiety, substance use) or general medical conditions that may increase the likelihood of acting on suicidal ideas; assessment of past and, particularly, recent suicidal behavior; delineation of current stressors and potential protective factors (eg, positive reasons for living, strong social support); and identification of any family history of suicide or mental illness (Category I). (APA, 2010)Higher score indicates better qualityAmerican Academy of Child and Adolescent Psychiatry (AACAP). Practice parameters for the assessment and treatment of children and adolescents with depressive disorders. J. Am. Acad. Child Adolesc. Psychiatry, 2007;
46(11):1503-1526. Available at:
http://www.aacap.org/App_Themes/AACAP/docs/practice_parameters/depressive_disorders_practice_parameter.pdfGelenberg AJ, Freeman MP, Markowitz JC, et al; American Psychiatric Association Work Group on Major Depressive Disorder. Practice guideline for the treatment of patients with major depressive disorder. 3rd ed. http://www.psychiatryonline.com/pracGuide/pracGuideTopic_7.aspx. Published October 2010. Accessed November 24, 2010.
Zimmerman M, Galione J. Psychiatrists' and Nonpsychiatrist Physicians' Reported Use of the DSM-IV Criteria for Major Depressive Disorder. J Clin Psychiatry. 2010;71:235-238.Dobscha SK, Gerrity MS, Corson K, Bahr A, Cuilwik NM. Measuring adherence to depression treatment guidelines in a VA primary care clinic. Gen Hosp Psychiatry. 2003;25:230-7.McGlynn EA, Asch SM, Adams J, Keesey J, Hicks J, DeCristofaro A, Kerr EA. The quality of health care delivered to adults in the United States. New England Journal of Medicine. 2003;348(26):2635-2645.Numerator Definition: The specific type and magnitude of the suicide risk assessment is intended to be at the discretion of the individual clinician and should be specific to the needs of the patient. At a minimum, suicide risk assessment should evaluate:
1. Risk (eg, age, sex, stressors, comorbid conditions, hopelessness, impulsivity) and protective factors (eg, religious belief, concern not to hurt family) that may influence the desire to attempt suicide.
2. Current severity of suicidality.
3. Most severe point of suicidality in episode and lifetime.
Low burden tools to track suicidal ideation and behavior such as the Columbia-Suicidal Severity Rating Scale can also be used.A suicide risk assessment should be performed at every visit for major depressive disorder during the measurement period.
This measure is an episode-of-care measure; the level of analysis for this measure is every visit for major depressive disorder during the measurement period. For example, at every visit for MDD, the patient should have a suicide risk assessment.
Use of a standardized tool or instrument to assess suicide risk will meet numerator performance. Standardized tools can be mapped to the concept "Intervention, Performed: Suicide Risk Assessment" included in the numerator logic below.TBDAll patient visits for those patients aged 6 through 17 years with a diagnosis of major depressive disorderEquals Initial PopulationNonePatient visits with an assessment for suicide riskNot ApplicableNoneFor every patient evaluated by this measure also identify payer, race, ethnicity and sexNone