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PSS-3: Three-question suicide screener for the ER

In the chaos of the emergency department (ED), it’s easy to miss something you’re not searching for. Up to one in five people who die by suicide visit an ED in the four weeks prior to their death. And those who die by suicide are more likely to come to the ED with a non-psychiatric complaint than a psychiatric one.

We’ve run an ER checklist of items to be removed from rooms designated for treatment of suicidal patients. But that doesn’t help patients who aren’t screened for suicidality.

Enter the Patient Safety Screener 3 (PSS-3), a suicide screening tool developed for the fast-paced world of the ED. The tool consists of a short introduction and three questions, with an optional fourth item if the person has previously attempted suicide. It’s meant to be given during triage or primary nursing assessment and has been validated for use on patients 18 and older.

The three questions are:
Over the past two weeks, have you felt down, depressed, or hopeless?
Over the past two weeks, have you had thoughts of killing yourself?
Have you ever attempted to kill yourself?

If the person answers “yes” to item three, then you follow up by asking them when the suicide attempt took place.

A “yes” to question one is a positive screen for depression. A “yes” to question two or if the person’s attempted suicide in the last six months is a positive screen for suicide risk.

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