The DAPS tool bundles together these separate screening measures into one easy to use and efficient tool. As a bundle, the DAPS tool offers 3 major advantages over traditional screening tools. First, the tool takes a broader approach to suicide risk with the aim of increasing utility. Suicide is a statistically rare event, especially in general medical settings. On the other hand, psychiatric conditions that themselves increase people’s risk of suicide are quite common, particularly in hospital settings. Rather than screening exclusively for suicidal thoughts and behavior, the DAPS tool screens for psychiatric conditions associated with an increased risk of suicide that are common in general medical settings. This approach to suicide screening is novel. It allows for the recognition of higher number of patients who may benefit from behavioral health interventions, whether or not they are “actively suicidal” at that moment. By not including extensive assessments of numerous suicide risk factors, the DAPS tool offers practical utility without losing much specificity. After all, persons in general hospital settings who at acutely increased risk of suicide (eg, a person admitted to the hospital following a suicide attempt via overdose) are already being identified.
The second advantage of the DAPS tool is that the information it obtains is actionable. Suicide screening tools, whether brief or comprehensive, are not immediately predictive and arrive at essentially the same conclusion—the person screened is deemed to fall into some risk stratification (eg, high, medium, low risk; acute vs non-acute risk). In general hospital settings, the responses to these stratifications are limited (eg, order a sitter, call a psychiatry consultation) and not specific to the level of risk. Furthermore, persons with psychiatric disorders may be at increased risk of suicide even if they deny having suicidal thoughts. The DAPS tool allows for the recognition of these persons, thus identifying opportunities for intervention. For example, a person who screens positive on the PHQ-2 portion of the DAPS but who denies having recent suicidal thoughts or behavior may not benefit from an immediate safety measure (eg, ordering a sitter) but may benefit from an evaluation and, if indicated, treatment for depression. Treating that person’s depression would decrease the longitudinal risk of suicide. If another person screens negative on the PHQ-2 but positive on the SASQ, then that person may benefit most from interventions targeting problem alcohol use, such as the initiation of a CIWA protocol in order to prevent the emergence of alcohol withdrawal during the hospitalization, but not necessarily from depression treatment.
The third main advantage of the DAPS tool is its ease of use. There are a limited number of psychiatrists and other mental health care workers in general hospitals, and that number is not adequate to have all psychiatric screens and assessments in performed by a specialist. The DAPS tool consists of scripted questions that any health care provider can read and follow. This type of instruction may be especially beneficial to health care providers who are unsure or uncomfortable about how to screen patients for suicide or psychiatric disorders. The DAPS tool provides these clinicians with language they can use comfortably when talking with patients. Alternatively, patients themselves can complete the DAPS questions, which frees up valuable time for providers to deliver other types of care. During a pilot project at one of our general hospitals, 20 general floor nurses were asked to implement the DAPS with their patients after receiving only a very brief set of instructions. On average, it took a nurse less than 4 minutes to complete the DAPS. Ninety percent of the nurses stated the DAPS tool would take “less time” or “no additional time” compared with the behavioral health questions in the current nursing admission assessment they were required to complete on every patient. Eighty-five percent found the tool “easy” or “very easy” to use.