Patients’ Opinions About Suicide Screening in a Pediatric Emergency Department

Abstract

Objective Understanding how children react to suicide screening in an emergency department (ED) can inform implementation strategies. This qualitative study describes pediatric patients’ opinions regarding suicide screening in that setting. Methods As part of a multisite instrument validation study, patients 10 to 21 years presenting with both psychiatric and nonpsychiatric complaints to an urban, tertiary care pediatric ED were recruited for suicide screening. Interviews with subjects included the question, “do you think ER nurses should ask kids about suicide/thoughts about hurting them-selves…why/why not?” Responses were transcribed verbatim and up-loaded into NVivo8.0 qualitative software for coding and content analysis. Results Of the 156 patients who participated in the study, 106 (68%) presented to the ED with nonpsychiatric complaints and 50 (32%) presented with psychiatric complaints. The patients’ mean (SD) age was 14.6 (2.8) years (range, 10–21 years), and 56% of the sample was female. All patients answered the question of interest, and 149 (96%) of 156 patients supported the idea that nurses should ask youth about suicide in the ED. The 5 most frequently endorsed themes were as follows: (1) identification of youth at risk (31/156, 20%), (2) a desire to feel known and understood by clinicians (31/156, 20%), (3) connection of youth with help and resources (28/156, 18%), (4) prevention of suicidal behavior (25/156, 16%), and (5) lack of other individuals to speak with about these issues (19/156, 12%). Conclusions Pediatric patients in the ED support suicide screening after being asked a number of suicide-related questions. Further work should evaluate the impact of suicide screening on referral practices and link screening efforts with evidence-based interventions.

Universal Mental Health Screening in Pediatric Primary Care: A Systematic Review

“…45 In another emergency department study, most youth said they were comfortable with being asked by a nurse about suicidality. 63 …”

“…Eight of the studies reviewed excluded families that did not speak English; 41, 50, 59, 63, 64, 67–69 many others (n=20) did not state the language in which screening was administered. Only 3 studies reported that parents or youth were able to ask for assistance when completing screens, 34, 42, 58 and one computer-administered screen had an option that allowed the respondent to listen to the questions as they were presented.…”

Asking Youth Questions About Suicide Risk in the Pediatric Emergency Department: Results From a Qualitative Analysis of Patient Opinions

“…(15) Two raters, a doctoral level clinical psychologist and a bachelor’s level research assistant, coded the data using the same themes drawn from a previous analysis. (14) Inter-rater agreement for these themes ranged from 88%–100%. Additionally, the raters used open coding procedures for other themes that emerged from the data.…”

“…In 2012, Ballard and colleagues published a qualitative investigation of patient opinions about suicide risk screening. (14) The five most salient themes that emerged from open coding responses of patients who supported suicide risk screening were: 1) identification of at-risk youth; 2) a desire for clinicians to know and understand their situation; 3) connection of youth with mental health help and resources; 4) prevention of suicidal behavior; and 5) lack of other individuals to speak with about these issues. These responses emphasized the importance of suicide risk screening, highlighting its potential to link patients to mental health treatment.…”

Patient Opinions About Screening for Suicide Risk in the Adult Medical Inpatient Unit

“…Studies have shown that pediatric patients in the emergency department favor suicide risk screening; 18, 19 however, it is not known how adult patients hospitalized for medical reasons will react to questions about suicide, particularly in the context of medical treatment. The objective of this paper is to describe patients’ opinions and reactions to universal screening for suicide risk in an inpatient medical hospital setting using qualitative analysis.…”