Universal Suicide Risk Screening in a Safety-Net Health System: Findings From 5.2 Million Encounters

OBJECTIVE: The authors aimed to examine whether universal suicide risk screening was associated with increased identification of suicide risk across demographic and clinical subgroups. METHODS: This retrospective observational study analyzed electronic health record data from 5,219,858 encounters at a safety-net health system (2010-2020). The primary outcome was encounter-level suicide risk identification. Multivariable logistic regression was used to estimate adjusted odds ratios (AORs) comparing the periods before and after implementation of universal screening. RESULTS: Suicide risk was identified in 0.7% of preimplementation encounters and 3.5% of postimplementation encounters (AOR=5.8, 95% CI=5.7-5.9). Relative increases were greatest among encounters involving older adults, charity or self-pay status, and Black patients and encounters in outpatient settings. CONCLUSIONS: Universal suicide risk screening substantially increased identification across settings, a finding that supports its use as a scalable strategy for equitable detection.