Identifying Adolescents at Highly Elevated Risk for Suicidal Behavior in the Emergency Department

King, Cheryl A.; Berona, Johnny; Czyz, Ewa K.; Horwitz, Adam G.; Gipson, Polly Y.

doi:10.1089/cap.2014.0049

Cited by 47 publications

(37 citation statements)

References 46 publications

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“…Sensitivity and specificity analyses highlight the ability of brief suicide risk screening approaches to identify individuals who will return to the ED for suicide-related reasons, with similar results as other previously published analyses (King, Berona, Czyz, Horwitz, & Gipson, 2015). These analyses underscore the importance of connecting positive responses on these screens to appropriate referrals for treatment.…”

Section: Discussionsupporting

confidence: 81%

Identification of At-Risk Youth by Suicide Screening in a Pediatric Emergency Department

et al. 2016

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Objective The pediatric emergency department (ED) is a critical location for the identification of children and adolescents at risk for suicide. Screening instruments that can be easily incorporated into clinical practice in EDs to identify and intervene with patients at increased suicide risk is a promising suicide prevention strategy and patient safety objective. This study is a retrospective review of the implementation of a brief suicide screen for pediatric psychiatric ED patients as standard of care. Methods The ASQ (Ask Suicide Screening Questions) was implemented in an urban pediatric ED for patients with psychiatric presenting complaints. Nursing compliance rates, identification of at-risk patients and sensitivity for repeated ED visits were evaluated using medical records from 970 patients. Results ASQ was implemented with a compliance rate of 79%. 53% of the patients who screened positive (237/448) did not present to the ED with suicide-related complaints. These identified patients were more likely to be male, African American and have externalizing behavior diagnoses. The ASQ demonstrated a sensitivity of 93% and specificity of 43% to predict return ED visits with suicide-related presenting complaints within six months of the index visit. Conclusions Brief suicide screening instruments can be incorporated into standard of care in pediatric ED settings. Such screens can identify patients who do not directly report suicide-related presenting complaints at triage and who may be at particular risk for future suicidal behavior. Results have the potential to inform suicide prevention strategies in pediatric EDs.

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Section: Discussionsupporting

confidence: 81%

Identification of At-Risk Youth by Suicide Screening in a Pediatric Emergency Department

et al. 2016

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“…For example, a recent study of adolescents in a general emergency department screened for suicide ideation/attempt, depressive symptoms, and alcohol/substance abuse found that youth endorsing all domains were most likely to engage in suicidal behavior two months later (King et al, 2015; Pena et al, 2012). Impairment due to alcohol/substance abuse may be a marker of a developmental trajectory with pervasive externalizing, disinhibited behavior and captures a group of individuals who are likely to engage in harmful mood-dependent behaviors (Zucker et al, 2011).…”

Section: Introductionmentioning

confidence: 99%

Psychopathology profiles of acutely suicidal adolescents: Associations with post-discharge suicide attempts and rehospitalization

Berona

Horwitz

Czyz

et al. 2017

Journal of Affective Disorders

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Background Suicidal adolescents are heterogeneous, which can pose difficulties in predicting suicidal behavior. The Youth Self-Report (YSR) psychopathology profiles predict the future onset of psychopathology and suicide-related outcomes. The present study examined the prevalence and correlates of YSR psychopathology profiles among suicidal adolescents and prospective associations with post-discharge rates of suicide attempts and psychiatric rehospitalization. Methods Participants were acutely suicidal, psychiatrically hospitalized adolescents (N=433 at baseline; n=355 at follow-up) who were enrolled in a psychosocial intervention trial during hospitalization. Psychopathology profiles were assessed at baseline. Suicide attempts and rehospitalization were assessed for up to 12 months following discharge. Results Latent profile analysis identified four psychopathology profiles: subclinical, primarily internalizing, and moderately and severely dysregulated. At baseline, profiles differed by history of non-suicidal self-injury (NSSI) and multiple suicide attempts (MA) as well as severity of suicide ideation, hopelessness, depressive symptoms, anxiety symptoms, substance abuse, and functional impairment. The dysregulation profiles predicted suicide attempts within 3 months post-discharge. The internalizing profile predicted suicide attempts and rehospitalization at 3 and 12 months. Limitations This study’s participants were enrolled in a randomized trial and were predominantly female, which limit generalizability. Additionally, only a history of NSSI was assessed. Conclusions The dysregulation profile was overrepresented among suicidal youth and associated with impairment in several domains as well as suicide attempts shortly after discharge. Adolescents with a severe internalizing profile also reported adverse outcomes throughout the study period. Psychopathology profiles warrant further examination in terms of their potential predictive validity in relation to suicide-related outcomes.

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“…The challenge of differentiating who is actually at a high risk for suicidal behavior is especially salient for Emergency Departments (EDs) serving large numbers of individuals presenting with self-inflicted injuries [3,4] and numerous risk factors. These include a study evaluating a multicomponent screening tool administered to adolescents in a general medical ED [7] and two studies [5,8] examining the predictive validity of Columbia-Suicide Severity Rating Scale (C-SSRS) [9] among adolescents and emerging adults seen in a psychiatric ED. [5] While promising suicide risk screening tools-such as the Ask Suicide-Screening Questions (ASQ) [6] -have been developed for youth presenting to EDs and demonstrated strong concurrent validity, there have been relatively few efforts addressing the substantial need for prospectively validated suicide risk assessment tools.…”

Section: Introductionmentioning

confidence: 99%

Self-Rated Expectations of Suicidal Behavior Predict Future Suicide Attempts Among Adolescent and Young Adult Psychiatric Emergency Patients

2016

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Youths' ratings indicative of lower confidence in maintaining safety uniquely predicted follow-up attempts and provided incremental validity over and above the clinician-administered assessment and improved its accuracy, suggesting their potential for augmenting suicide risk formulation. Assessing youths' own perceptions of suicide risk appears to be clinically useful, feasible to implement in PE settings, and, if replicated, promising for improving identification of youth at risk for suicidal behavior.

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Identifying Adolescents at Highly Elevated Risk for Suicidal Behavior in the Emergency Department

Abstract: In this study, use of a higher screen threshold (multiple suicide risk factors) showed promise for identifying highly elevated acute risk for suicidal behavior.

Cited by 47 publications

References 46 publications

Identification of At-Risk Youth by Suicide Screening in a Pediatric Emergency Department

Identification of At-Risk Youth by Suicide Screening in a Pediatric Emergency Department

Psychopathology profiles of acutely suicidal adolescents: Associations with post-discharge suicide attempts and rehospitalization

Self-Rated Expectations of Suicidal Behavior Predict Future Suicide Attempts Among Adolescent and Young Adult Psychiatric Emergency Patients

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