Key PointsQuestionAre results of universal and selective screening for suicide risk implemented in a pediatric emergency department associated with future suicidal behaviors?FindingsIn this cohort study of 15 003 youths aged 8 to 18 years, positive screens were significantly associated with subsequent suicide-related hospital visits compared with standard emergency department procedures. Screening also more than doubled the detection of suicide risk compared with treatment as usual.MeaningThese findings suggest that screening for suicide risk in pediatric emergency departments is an effective approach to identify risk for subsequent suicide-related emergency department visits.

Early detection and prevention of psychosis has become an international priority. Much of this work has focused on youth presenting with attenuated symptoms of psychosis—those at clinical high risk for psychosis (CHR)—given their elevated probability of developing the full disorder in subsequent years. Individuals at CHR may be prone to exacerbated psychological distress during the coronavirus 2019 (COVID-19) pandemic and its subsequent physical isolation measures, as a result of heightened stress sensitivity and comorbid mental health problems. Telepsychotherapy holds promise for reaching this population, especially during the current COVID-19 outbreak. However, there are limited evidence-based guidelines or interventions for use of telepsychotherapy with this population. In this article, we review common clinical issues for individuals at CHR and how they might be exacerbated by the COVID-19 pandemic. We then review best practices for treatment and adaptations for telepsychotherapy for individuals at CHR, and highlight real clinical issues that we are currently experiencing in a United States–based specialized CHR clinic as we conduct telepsychotherapy via videoconferencing. We conclude with questions for those in the field to contemplate, as well as potential challenges and benefits in using telepsychotherapy with individuals at CHR and their families.

ur research provides preliminary evidence that suicide risk screening is warranted in patients as young as 8-9 years old presenting to the emergency department (ED) with behavioral and mental health symptoms. The goal of this retrospective cohort study (N ¼ 2,466 unique patient visits) was to assess the value of suicide risk screening in children younger than 10 years old who present to the ED with behavioral and mental health concerns. The Johns Hopkins Hospital pediatric ED began screening with the Ask Suicide-Screening Questions (ASQ) for patients 8-21 years old who presented with a behavioral or mental health concern in March 2013 as ED standard of care. We examined the demographic and clinical differences between younger (8-9 years old; n ¼ 270) and older (10-21 years old; n ¼ 2,196) youths who were screened for suicide risk with the ASQ (from March 13, 2013 through December 31, 2016). In summary, 36% of 8-and 9-yearold patients who came to the ED for behavioral and mental health concerns screened positive for suicide risk on the ASQ. The younger patients who screened positive were more likely to present with externalizing symptoms and hallucinations and less likely to present with suicidal ideation or an attempt than their older counterparts. Importantly, 71.1% of 8-to 9-year-old patients who screened positive did not present to the ED for suicidal ideation or attempt vs 50.1% (614/1,226) of patients older than age 10 years.This research is particularly timely and impactful given the 57.4% increase from 2007 to 2018 in the suicide rate among young people 10-24 years old in the United States and among younger subgroups of children: girls 10-14 years old and Black children 5-11 years old. 1,2 The suicide rate of girls 10-14 years old has tripled from 0.5 per 100,000 in 1999 to 1.7 per 100,000 in 2017. 2 ED visit rates among youths with self-inflicted injury, especially in girls 10-14 years old, also increased substantially during a similar time period. 3 The growing literature on preadolescent suicide also reveals stark racial disparities. During the years 2001-2015, Black boys and girls younger than age 13 O

No abstract

No abstract