Background: Suicide is the second leading cause of death in the military, with rates increasing dramatically over the past decade. Universal suicide prevention screening in primary care is as one possible solution, but current screening tools "miss" over half of patients who attempt suicide.

Objective/Hypothesis: The primary objective is to develop a brief and practical algorithm that can be used by primary care providers to more accurately identify high-risk patients than current screening methods. This algorithm will assess chronic suicide risk using the Suicide Cognitions Scale (SCS), a new measure that has shown promise in pilot studies for identifying suicidal patients who deny emotional distress and suicide risk. It is expected that the SCS will significantly improve the identification of suicidal patients and predict future suicide attempts, even among patients who deny suicidal intent.

Specific Aims: The primary aims of this study are to develop a more accurate universal screening method for predicting future suicide attempts in military primary care clinics by reducing false negatives and to quantify the false negative rate of current screening methods across patient subgroups (e.g., gender, age, race).

Study Design: Patients at military primary care clinics (n > 5000) will complete several self-report measures, including the SCS and current screening tools used in the military (i.e., PHQ2 and PHQ9). Follow-up assessments will be conducted at 6 and 12 months to determine the incidence of suicide attempts. Analyses will determine which screening items best predict suicide attempts in the full sample and in patient subgroups.

Relevance: No universal screening methods currently exist that can predict suicide attempts with acceptable accuracy or reliability, and the majority of individuals who make a suicide attempt deny suicidal ideation or intent or are "missed" by current screening methods. Reduced false negatives would improve suicide prevention by enhancing our ability to connect at-risk individuals with services and interventions.