Implementing Suicide Risk Screening in a Pediatric Primary Care Setting: From Research to Practice

Horowitz, Lisa M.; Bridge, Jeffrey A.; Tipton, Mary V.; Abernathy, Ted; Mournet, Annabelle M.; Snyder, Deborah; Lanzillo, Elizabeth C.; Powell, Daniel; Schoenbaum, Michael; Brahmbhatt, Khyati; Pao, Maryland

doi:10.1016/j.acap.2021.10.012

Cited by 32 publications

(16 citation statements)

References 27 publications

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“…Mathias and colleagues actually found that suicidal ideation declined compared with baseline after repeated assessments using the Suicidal Ideation Questionnaire-Junior in a population at risk; this suggests that screening is safe and may be helpful to teens struggling with suicidal ideation 92. Moreover, previous studies describing opinions for screening show that most pediatric patients and parents/guardians support screening for suicide risk in healthcare settings 9495. To our knowledge, iatrogenic risk of asking about suicide has not been evaluated in pre-teens; caution should be used in generalizing these results to younger age groups.…”

Section: Strategies For Prevention Of Suicide In Young People In Clin...mentioning

confidence: 99%

“…Once a patient screens positive for suicide risk, a follow-up assessment is a critical best practice, as disposition based on screening alone can fail to respond appropriately to real suicide risk and result in inefficient use of resources 7395Table 1. shows commonly used assessment measures that clinicians can use after a positive screen.…”

Section: Strategies For Prevention Of Suicide In Young People In Clin...mentioning

confidence: 99%

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Suicide in young people: screening, risk assessment, and intervention

Hughes

Horowitz

Ackerman

et al. 2023

BMJ

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Suicide is the fourth leading cause of death among young people worldwide and the third leading cause of death among those in the US. This review outlines the epidemiology of suicide and suicidal behavior in young people. It discusses intersectionality as an emerging framework to guide research on prevention of suicide in young people and highlights several clinical and community settings that are prime targets for implementation of effective treatment programs and interventions aimed at rapidly reducing the suicide rate in young people. It provides an overview of current approaches to screening and assessment of suicide risk in young people and the commonly used screening tools and assessment measures. It discusses universal, selective, and indicated evidence based suicide focused interventions and highlights components of psychosocial interventions with the strongest evidence for reducing risk. Finally, the review discusses suicide prevention strategies in community settings and considers future research directions and questions challenging the field.

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Section: Strategies For Prevention Of Suicide In Young People In Clin...mentioning

confidence: 99%

Section: Strategies For Prevention Of Suicide In Young People In Clin...mentioning

confidence: 99%

Suicide in young people: screening, risk assessment, and intervention

Hughes

Horowitz

Ackerman

et al. 2023

BMJ

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“…The main advantages of the ASQ are that it is brief (4 items), free of charge, has widespread use and validation in multiple settings and age groups, and is integrated into youth suicide risk clinical pathways. 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 In a sample in which most youths present with physical symptoms, the performance of the ASQ will be indistinguishable from the CASSY. Although the ASQ was initially validated against a concurrent measure of SI, its ability to predict future SAs is logical given the association between more severe SI and future suicidal behavior.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…Flexibility to customize sensitivity and specificity, a dimensional output that provides the likelihood of predicting an SA, and higher accuracy for predicting SAs for those with behavioral health symptoms are the main advantages of the CASSY. Using these tools as part of a clinical pathway, which may include further assessments with the ASQ Brief Suicide Safety Assessment or the Columbia Suicide Severity Rating Scale, may provide efficient triaging for those at greatest risk. Studies conducted among adults suggest that both tools should be paired with brief interventions to promote safety planning and linkage to services that can reduce the risks for a subsequent SA …”

Section: Discussionmentioning

confidence: 99%

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Prediction of Suicide Attempts and Suicide-Related Events Among Adolescents Seen in Emergency Departments

et al. 2023

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ImportanceScreening adolescents in emergency departments (EDs) for suicidal risk is a recommended strategy for suicide prevention. Comparing screening measures on predictive validity could guide ED clinicians in choosing a screening tool.ObjectiveTo compare the Ask Suicide-Screening Questions (ASQ) instrument with the Computerized Adaptive Screen for Suicidal Youth (CASSY) instrument for the prediction of suicidal behavior among adolescents seen in EDs, across demographic and clinical strata.Design, Setting, and ParticipantsThe Emergency Department Study for Teens at Risk for Suicide is a prospective, random-series, multicenter cohort study that recruited adolescents, oversampled for those with psychiatric symptoms, who presented to the ED from July 24, 2017, through October 29, 2018, with a 3-month follow-up to assess the occurrence of suicidal behavior. The study included 14 pediatric ED members of the Pediatric Emergency Care Applied Research Network and 1 Indian Health Service ED. Statistical analysis was performed from May 2021 through January 2023.Main Outcomes and MeasuresThis study used a prediction model to assess outcomes. The primary outcome was suicide attempt (SA), and the secondary outcome was suicide-related visits to the ED or hospital within 3 months of baseline; both were assessed by an interviewer blinded to baseline information. The ASQ is a 4-item questionnaire that surveys suicidal ideation and lifetime SAs. A positive response or nonresponse on any item indicates suicidal risk. The CASSY is a computerized adaptive screening tool that always includes 3 ASQ items and a mean of 8 additional items. The CASSY’s continuous outcome is the predicted probability of an SA.ResultsOf 6513 adolescents available, 4050 were enrolled, 3965 completed baseline assessments, and 2740 (1705 girls [62.2%]; mean [SD] age at enrollment, 15.0 [1.7] years; 469 Black participants [17.1%], 678 Hispanic participants [24.7%], and 1618 White participants [59.1%]) completed both screenings and follow-ups. The ASQ and the CASSY showed a similar sensitivity (0.951 [95% CI, 0.918-0.984] vs 0.945 [95% CI, 0.910-0.980]), specificity (0.588 [95% CI, 0.569-0.607] vs 0.643 [95% CI, 0.625-0.662]), positive predictive value (0.127 [95% CI, 0.109-0.146] vs 0.144 [95% CI, 0.123-0.165]), and negative predictive value (both 0.995 [95% CI, 0.991-0.998], respectively). Area under the receiver operating characteristic curve findings were similar among patients with physical symptoms (ASQ, 0.88 [95% CI, 0.81-0.95] vs CASSY, 0.94 [95% CI, 0.91-0.96]). Among patients with psychiatric symptoms, the CASSY performed better than the ASQ (0.72 [95% CI, 0.68-0.77] vs 0.57 [95% CI, 0.55-0.59], respectively).Conclusions and RelevanceThis study suggests that both the ASQ and the CASSY are appropriate for universal screening of patients in pediatric EDs. For the small subset of patients with psychiatric symptoms, the CASSY shows greater predictive validity.

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Preventing adolescent suicide: Recommendations for policymakers, practitioners, program developers, and researchers

Morris‐Perez,

Abenavoli,

Benzekri

et al. 2023

Social Policy Report

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For much of the past decade, suicide has been the second leading cause of death for adolescents in the United States, and suicide rates among adolescents have been rising for the last 15 years. Suicidal thoughts and behaviors among adolescents were common before COVID-19 and have become an increasing public health priority in the pandemic′s wake. In this Social Policy Report, we review evidence for suicide prevention strategies designed to address these rising trends. We make recommendations for federal, state, and local policymakers and practitioners; program developers in organizations that design and implement programming for youth; and academic and nonacademic researchers. Where research evidence is strong, we suggest legislation, funding, and implementation. In areas where gaps in evidence exist, we recommend program development and research. Our recommendations follow the order in a taxonomy adapted from the Centers for Disease Control and Prevention, beginning with strategies that change the structural conditions in which adolescents live and concluding with strategies that support adolescents following a suicide (i.e., postvention). We find strong evidence for, and recommend policy implementation of: restricting access to lethal means; LGBTQ+ affirming policies; screening for suicide risk in medical settings; and community-wide investments via the Garrett Lee Smith Memorial Act. In schools, we find benefits of, and recommend funding and implementation of, youth-focused programs. Even so, gaps exist: (a) research on economic policies for adolescents is nonexistent; (b) while mental health care access is a barrier, we do not know how to reduce youth suicide rates via changing care access; (c) data on crisis lines are encouraging but descriptive; and (d) school personnel training increases knowledge and confidence but not adolescent help-seeking. Finally, guidelines for response following a suicide loss focus on immediate support and are based on limited research; this is an area for program development and research.

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Implementing Suicide Risk Screening in a Pediatric Primary Care Setting: From Research to Practice

Cited by 32 publications

References 27 publications

Suicide in young people: screening, risk assessment, and intervention

Suicide in young people: screening, risk assessment, and intervention

Prediction of Suicide Attempts and Suicide-Related Events Among Adolescents Seen in Emergency Departments

Preventing adolescent suicide: Recommendations for policymakers, practitioners, program developers, and researchers

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