Date of Degree

12-2025

Document Type

Doctoral Project

Degree Name

Doctor of Nursing Practice (DNP)

Program

Nursing

Advisor

Michael D. Moon

Abstract

Suicide is a leading cause of death in the United States, with anxiety and depression recognized as independent risk factors for suicidal ideation (Centers for Disease Control and Prevention, 2024 September 26; Grant et al., 2023; Li et al., 2022; Moon et al., 2025; Wiebengo et al., 2021). Incorporating valid screening tools like the General Anxiety Disorder-7 and the Columbia-Suicide Severity Rating Scale can help identify suicidal ideation early, enabling quicker provider intervention (Johnson et al., 2019; O’Connor et al., 2022). The purpose of this project was to implement the Columbia-Suicide Severity Rating Scale as a standardized screening tool for adults diagnosed with generalized anxiety disorder in an outpatient psychiatric clinic and to incorporate safety planning for patients who screened positive. Project objectives included 1) increasing screening of patients with general anxiety disorder for suicidal ideation, 2) completing a safety plan during the office visit for all patients who screened positive, and 3) evaluating all patients who screened positive to determine if psychiatric hospitalization or outpatient management was warranted. Interventions involved provider education, utilization of the Veterans Affairs/Department of Defense clinical practice guidelines for assessing and managing patients at risk for suicide, integrating the Columbia-Suicide Severity Rating Scale and safety plan into workflow, and implementation of criteria to determine risk level in deciding whether hospitalization or outpatient management was needed. Over the 10-week implementation period, 64% of eligible patients were screened using the Columbia-Suicide Severity Rating Scale. Among those who screened positive, 30% completed a safety plan and 100% were determined to be eligible for outpatient management. Routine use of the Columbia-Suicide Severity Rating Scale, paired with safety planning, is feasible in an outpatient setting and improves identification of patients at risk for suicide who have generalized anxiety disorder. Electronic medical record integration and telehealth-friendly adaptations are essential for sustainability.

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