Lowering the Age Limit in Suicide Risk Screening: Clinical Differences and Screening Form Predictive Ability

Abstract

ur research provides preliminary evidence that suicide risk screening is warranted in patients as young as 8-9 years old presenting to the emergency department (ED) with behavioral and mental health symptoms. The goal of this retrospective cohort study (N ¼ 2,466 unique patient visits) was to assess the value of suicide risk screening in children younger than 10 years old who present to the ED with behavioral and mental health concerns. The Johns Hopkins Hospital pediatric ED began screening with the Ask Suicide-Screening Questions (ASQ) for patients 8-21 years old who presented with a behavioral or mental health concern in March 2013 as ED standard of care. We examined the demographic and clinical differences between younger (8-9 years old; n ¼ 270) and older (10-21 years old; n ¼ 2,196) youths who were screened for suicide risk with the ASQ (from March 13, 2013 through December 31, 2016). In summary, 36% of 8-and 9-yearold patients who came to the ED for behavioral and mental health concerns screened positive for suicide risk on the ASQ. The younger patients who screened positive were more likely to present with externalizing symptoms and hallucinations and less likely to present with suicidal ideation or an attempt than their older counterparts. Importantly, 71.1% of 8-to 9-year-old patients who screened positive did not present to the ED for suicidal ideation or attempt vs 50.1% (614/1,226) of patients older than age 10 years.This research is particularly timely and impactful given the 57.4% increase from 2007 to 2018 in the suicide rate among young people 10-24 years old in the United States and among younger subgroups of children: girls 10-14 years old and Black children 5-11 years old. 1,2 The suicide rate of girls 10-14 years old has tripled from 0.5 per 100,000 in 1999 to 1.7 per 100,000 in 2017. 2 ED visit rates among youths with self-inflicted injury, especially in girls 10-14 years old, also increased substantially during a similar time period. 3 The growing literature on preadolescent suicide also reveals stark racial disparities. During the years 2001-2015, Black boys and girls younger than age 13 O

Correlates and predictors of the severity of suicidal ideation in adolescence: an examination of brain connectomics and psychosocial characteristics

“…Across ‘psychosocial‐only’ models, higher baseline internalizing symptom severity and younger age at baseline was associated with higher levels of SI and greater severity of internalizing symptoms at follow‐up. Recent research on suicide risk screening has reported that younger patients who present with externalizing symptoms (two characteristics consistent with our findings) and hallucinations, but not with SI or attempts, screened positive for suicide risk, suggesting that screening for suicide risk can be beneficial for children as young as 8 or 9 years of age (Cwik et al., 2021). In the models of psychosocial‐only variables, sex, race/ethnicity (people‐of‐color compared to White participants), the interval between timepoints, and tanner stage (pubertal stage) at follow‐up were associated with increased severity of internalizing severity, but not with increased severity of SI.…”

“…It is well documented that exposure to stressful life events is a potent risk factor for the development of STBs in adolescents (Dykxhoorn, Hatcher, Roy-Gagnon, & Colman, 2017;Miller & Prinstein, 2019), and in particular lifetime sexual/physical abuse, perceived physical safety at school, and parental support are important indicators of SI in pre-adolescents (Walsh, Sheehan, & Liu, 2021). It is possible that participants in our sample (Cwik et al, 2021). In the models of psychosocial-only variables, sex, race/ethnicity (people-of-color compared to White participants), the interval between timepoints, and tanner stage (pubertal stage) at follow-up were associated with increased severity of internalizing severity, but not with increased severity of SI.…”

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 ). 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 3% ( 48 ) to 10% ( 36 ).…”

“…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 3% ( 48 ) to 10% ( 36 ). 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 ).…”

“…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 ).…”