Evaluating Iatrogenic Risk of Youth Suicide Screening Programs

Abstract

HE PRESIDENT'S NEW FREEdom Commission 1 and the Children's Mental Health Screening and Prevention Act 2 recommend increased screening for suicidality and mental illness. The recent enactment of the Garrett Lee Smith Memorial Act 3 further supports the development of youth suicide prevention and intervention programs. Despite the proliferation of screening programs in recent years (eg, Signs of Suicide, 4 Teen-Screen 5 ), the current debate about possible iatrogenic effects of other suicide preventive interventions, 6,7 and the belief that prevention programs may "spur troubled youngsters to try suicide," 8 the potential harm of screening for suicide remains unstudied. 9,10 Screening strategies are based on the valid premise that suicidal adolescents are underidentified [11][12][13][14][15] ; have an active, often treatable, mental illness [16][17][18] ; and exhibit identifiable risk factors. 11 Evidence for the clinical validity and reliability of school-based screening procedures has recently emerged. Use of the Suicidal Ideation Questionnaire (SIQ) in a midwestern US high school yielded a sensitivity ranging from 83% to 100%, with specificity from 49% to 70%. 19 The Suicide Risk Screen's use among 581 students in 7 high schools had a sensitivity ranging from 87% to 100%, with specificity from 54% to 60%. 20 Among 2004 teenagers from 8 New York metropoli-

Randomized trial of a gatekeeper program for suicide prevention: 1-year impact on secondary school staff.

“…A second question is how to integrate gatekeeper training with other strategies such as youth screening (Gould, et al, 2005;Shaffer, Scott, Wilcox, Maslow, & Hicks, 2004;Thompson & Eggert, 1999) and approaches that combine screening with education (Aseltine & DeMartino, 2004)? First, the success of gatekeeper training as well as these other approaches relies on the existence of adequate networks for referral of students for crisis management and mental health treatment, or of informal but effective support.…”

Does asking about suicide and related behaviours induce suicidal ideation? What is the evidence?

“…Conducted using samples of both adolescents and adults and in general and at-risk populations, none found a statistically significant increase in suicidal ideation in participants as a result of being asked about their suicidal thoughts. Gould et al (2005) screened high-school students (n = 1172) for suicidal ideation and behaviour 2 days after an initial suicide questionnaire, while the control group (n = 1170) was not asked any sensitive questions. The study found that high-school students asked about suicidality had significantly decreased participant distress scores compared to controls (p = 0.01).…”

Suicide and Suicide Attempts in Adolescents

“…In a screening program, asking high school students about suicidal ideation and behavior did not create distress or increase suicidal ideation, even in high-risk students. 13 The adolescent should be interviewed separately from the parent, because the patient may be more likely to withhold important information in the parent's presence. Information should also be sought from parents and others as appropriate.…”