Identifying and Treating Childhood Suicide Risk Through Virtual Screening and Evidence-Based Care: A Retrospective Patient Cohort Study (Preprint)

Abstract

BACKGROUND Suicide is responsible for the deaths of more children than any single major medical illness and the second leading cause of death among children 10-14 years old. Universal suicide risk screening is recommended for all children 12 and older, and for those under 12 when clinically indicated. Virtual outpatient care represents a critical suicide risk screening point. OBJECTIVE To determine whether childhood suicide risk can be assessed and treated through virtual mental healthcare. METHODS This retrospective cohort study used electronic health record data from patients served at a virtual mental health care platform serving children and their families from May 2023 to February 2024. The sample included patients aged 3 - 14 who completed screening and a comprehensive diagnostic assessment (n=1434) and a subset who completed 12 or more treatment sessions (n=660). Mean age was 9.1 years. Patients 8 and older completed a universal suicide risk screening and children under 8 completed screening based on established criteria as a part of the standard of care. Current and lifetime suicide risk was assessed using caregiver-report (ASQ) and child-report (C-SSRS) measures. Associations with age, sex, race/ethnicity, severity of illness (CGI-S), depression (MFQ), and clinical improvement after 12 or more sessions (CGI-I) were examined. Data was analyzed for the entire cohort and two age subgroups (ages 3-7 and 8-14). RESULTS 100% of children ages 8-14 were screened at stage one or two. 15.5% of children ages 3-7 were screened. Overall, 19.0% (193/1016) of children ages 8-14 and 6.5% (27/418) of children 3-7 screened positive for current suicide risk with a mean age of 10 (SD=2.2; range 5-14). Lifetime suicide risk was 27.7% (281/1016) for children 8-14. Age, sex, and race/ethnicity differences were found. Current suicide risk was significantly associated with depression and greater severity of illness. After 12 or more sessions of evidence-based virtual care, there was no significant difference in improvement by suicide risk status (75% with positive screen versus 79% with negative screen improved). CONCLUSIONS Childhood suicide risk assessment is feasible and effective within a virtual care setting. Suicide risk is significant for children seeking virtual mental health care. Evidence-based virtual care is as effective for children with suicidal ideation and/or behaviors as for those without suicide risk. Universal screening for suicide risk for all children 8 and older presenting for mental healthcare is feasible and clinically indicated.