Self-reported Symptoms of Anxiety Predict Positive Suicide Risk Screening in Adolescents Presenting to the Emergency Department

Abstract

Objective:The objective of this study was to assess whether patient-reported anxiety symptoms are associated with suicide risk in pediatric emergency department (ED) patients. An additional objective was to examine differences between patients presenting for medical/surgical or psychiatric complaints.Methods: Pediatric patients aged 10 to 21 years were recruited from 3 pediatric EDs. Participants completed self-report questionnaires assessing for suicidal ideation and behavior, in addition to questions of interest about recent feelings of unbearable anxiety and depression. Adjusted odds ratios were calculated to assess the relationship between endorsement of recent anxiety and screening positive for suicide risk.Results: Data were analyzed from 522 participants, including 344 presenting with medical/surgical chief complaints and 178 presenting with psychiatric complaints. Overall, 28.9% of participants screened positive for suicide risk, 29.9% endorsed recent feelings of anxiety, and 24.3% endorsed recent feelings of depression. Patients who self-reported recent anxiety symptoms were 5 times more likely to screen positive for suicide risk (adjusted odds ratios = 5.18, 95% confidence interval = 3.06-8.76). Analysis of the 344 medical/surgical patients revealed that this subsample was also 5 times more likely to screen positive for suicide risk if they endorsed recent anxiety (adjusted odds ratios = 4.87, 95% confidence interval = 2.09-11.36).Conclusions: Self-reported suicidal ideation and feelings of unbearable anxiety are prevalent among patients presenting to pediatric EDs. Patients who self-report recent feelings of unbearable anxiety are significantly more likely to screen positive for suicide risk, regardless of whether their presenting complaint is medical/surgical or psychiatric in nature.

Suicide attempts presenting to the emergency department before and during the COVID-19 pandemic: a comparative study

“…15 A study of 522 teenage patients admitted to an ED in the United Kingdom found that patients reporting recent feelings of anxiety had more than five times the risk of suicide (OR, 5.18) than those who did not. 16 Emotional stress can lead to substance abuse and depression, which can in turn lead individuals to choose suicide as the last way out. 17 The spread of COVID-19 is related to emotional stress.…”

Suicide Screening Tools for Pediatric Emergency Department Patients: A Systematic Review

“…In studies of patients with all chief complaints (including psychiatric and medical/surgical), the positivity rate ranged from 8% ( 6 ) to 29% ( 47 ). In studies that only included patients with psychiatric chief complaints (or studies that included a breakdown of solely psychiatric presentations), positivity rates ranged from 36% ( 20 ) to 66% ( 47 ).…”

“…A few papers explored the ASQ's effectiveness in screening younger populations, as young as 8 years old ( 6 , 14 , 20 , 22 , 27 ). Those who screen positive on the ASQ tend to be more often female ( 6 , 14 , 20 , 22 , 29 , 42 , 47 ), older ( 14 , 20 , 22 , 29 , 42 ); and, in “all comer” samples, to present with a psychiatric/suicide-related complaint ( 6 , 22 , 43 ). Being Black/African- American was protective in some studies ( 14 , 42 ) and a risk factor in others ( 20 , 22 , 29 ).…”

“…In samples that included patients with any chief complaint, the positivity rate of the SIQ ranged from 4% ( 40 ) to 29% ( 47 ). In studies that only sampled patients with psychiatric chief complaints, or studies that included a breakdown of solely psychiatric presentations, positivity rates ranged from 40% ( 10 ) to 66% ( 47 ). In contrast, in studies with patients with only medical/surgical complaints, or studies that included a breakdown of solely non-psychiatric presentations, the positivity rates ranged from 0% ( 34 ) to 10% ( 47 ).…”

“…In studies that only sampled patients with psychiatric chief complaints, or studies that included a breakdown of solely psychiatric presentations, positivity rates ranged from 40% ( 10 ) to 66% ( 47 ). In contrast, in studies with patients with only medical/surgical complaints, or studies that included a breakdown of solely non-psychiatric presentations, the positivity rates ranged from 0% ( 34 ) to 10% ( 47 ). Those who screened positive on the SIQ tended to more often be female ( 39 , 47 ), and more often presenting with psychiatric complaints: in universal screening studies, the proportion of positive screens that were positive ranged from 77% ( 10 , 47 ) to 87% ( 43 ).…”