title: Double RASS cutpoint accurately diagnosed suicidal risk in females with long-term conditions attending the emergency department compared to their male counterparts.
abstract: BACKGROUND
  Suicidal risk is often unrecognized in emergency department (ED). We aimed to assess its prevalence in patients with long-term conditions (LTCs) attending an ED and to test whether gender differences influence suicidal risk assessment, using the diagnostic accuracy properties of the Risk Assessment Suicidality Scale (RASS).
  
  
  METHODS
  The RASS was administered to 349 patients with diabetes, COPD and rheumatic diseases visiting an ED. The MINI interview was used as the criterion standard. ROC curve analysis was performed to determine the optimal RASS cutpoint for suicidal risk separately for males and females. Somatic (PHQ-15) and depressive (PHQ-9) symptoms were also assessed and factors associated with suicidal risk across gender were determined in hierarchical regression models.
  
  
  RESULTS
  The prevalence of suicidal risk according to the MINI was 22.9%; 16.6% of patients were at low, 5.1% at moderate, and 0.9% at high risk. At an optimal cutpoint of 270, RASS had 81.3% sensitivity and 81.8% specificity. The optimal RASS cutpoint for females (340) was double the cutpoint for males (175). Somatic symptom burden was associated with suicidal risk in both sexes but it became non-significant after depressive symptoms were taken into account; suicidal risk was also associated with history of depression in females and lower income in males.
  
  
  CONCLUSIONS
  There is a high prevalence of suicidal risk in patients with LTCs attending the ED. As the optimal RASS cutpoint for females was double the cutpoint for males, clinicians should bear in mind gender differences when assessing for suicidal risk in the ED.
authors.affiliation: Department of Psychiatry, Division of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece.
authors.forename: Elisavet
authors.initials: E
authors.lastname: Ntountoulaki
authors.affiliation: Psychiatry Research Group, Medical School, University of Manchester, Manchester, UK.
authors.forename: Elspeth
authors.initials: E
authors.lastname: Guthrie
authors.affiliation: Department of Psychiatry, Division of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Kotsis
authors.affiliation: Department of Psychiatry, Division of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece.
authors.forename: Vassiliki
authors.initials: V
authors.lastname: Paika
authors.affiliation: Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece.
authors.forename: Athina
authors.initials: A
authors.lastname: Tatsioni
authors.affiliation: Psychiatry Research Group, Medical School, University of Manchester, Manchester, UK.
authors.forename: Barbara
authors.initials: B
authors.lastname: Tomenson
authors.affiliation: Third Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece.
authors.forename: Konstantinos N
authors.initials: KN
authors.lastname: Fountoulakis
authors.affiliation: Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil.
authors.forename: Andre F
authors.initials: AF
authors.lastname: Carvalho
authors.affiliation: Department of Psychiatry, Division of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece. Electronic address: tyfantis@cc.uoi.gr.
authors.forename: Thomas
authors.initials: T
authors.lastname: Hyphantis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001008:Anxiety Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D002908:Chronic Disease / Q000453:epidemiology* / Q000523:psychology*; D015331:Cohort Studies; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006115:Greece; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011594:Psychometrics / Q000706:statistics & numerical data*; D018570:Risk Assessment / Q000706:statistics & numerical data*; D012737:Sex Factors; D012959:Socioeconomic Factors; D013223:Statistics as Topic; D059020:Suicidal Ideation; D013405:Suicide / Q000523:psychology* / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D000092864:Suicide Prevention