Comparing structured versus unstructured suicide risk assessment across health professionals and the general population: a vignette-based study protocol (CARE)

Background – Suicide risk assessment is a complex clinical task characterized by substantial variability in judgment and low predictive accuracy, even among experienced clinicians. Standardized instruments such as the Columbia Suicide Severity Rating Scale (C-SSRS) have improved the structure of assessments, yet inter-rater agreement remains limited, particularly for intermediate risk categories. Moreover, insufficient suicide assessment training among healthcare professionals and widespread misconceptions about suicide in the general population further compromise the accuracy and consistency of risk estimates. The CARE study aims to address these gaps by examining variability in suicide risk estimates and evaluating whether brief suicide assessment training and the use of the C-SSRS can enhance agreement across different groups and over time. Method – The study employs a vignette-based randomized experimental design to directly compare suicide risk estimates across ten participant groups, including mental health professionals, other healthcare workers, university students, and individuals without clinical backgrounds. At baseline, participants will be randomly assigned to an experimental condition involving brief training and the use of the C-SSRS or to a non-experimental condition requiring risk estimates based solely on subjective impressions and/or clinical experience. Each participant will evaluate six vignettes representing low, moderate, and high suicide risk. After two weeks, participants will complete a follow-up assessment with six additional vignettes to examine within-person consistency. Primary outcomes include between-group and within-subject discrepancies in risk estimates, while secondary outcomes focus on differences between C-SSRS and non-C-SSRS conditions. Discussion – The CARE study will provide one of the most comprehensive vignette-based evaluations of suicide risk assessment across healthcare professionals and laypeople. Findings may inform targeted training, support the integration of standardized tools, and guide public health strategies aimed at improving early recognition and consistent evaluation of suicide risk.