Sexual History Documentation and Screening in Adolescent Females with Suicidal Ideation in the Emergency Department

Abstract

Adolescents with mental illness often seek care in the emergency department (ED) and are more likely to engage in risky behaviors such as substance abuse and unprotected sex, increasing their risk of sexually transmitted infections (STI), unintended pregnancy, and non-consensual sex. This was a retrospective study of 312 females, aged 13–17 years, presenting to the pediatric ED with the chief complaint of suicidal ideation from February to May 2018. Electronic medical records were reviewed for demographics, psychiatric history, sexual history, and testing for pregnancy or STI. The primary outcome was the documentation of the presence or absence of prior sexual activity. Secondary outcomes included documented aspects of sexual history and pregnancy or STI testing performed in the ED. Of the 312 eligible patients, 144 (46.2%) had a documented sexual history, and of those 50 (34.7%) reported being sexually active. Sexual history documentation was not associated with patient age, race, ethnicity, insurance, or the gender of the ED provider. A history of anxiety and a recent suicide attempt were associated with a lack of sexual history documentation (p = 0.03). Of the sexually active patients, 28 (56%) had documentation of contraception use. Pregnancy testing was performed in 67.3% of all patients and 80% of sexually active patients. Only 10 patients had STI testing in the ED, with most testing occurring in those with sexual history documentation (p = 0.007). In conclusion, more than half of females with suicidal ideation in our ED had no documentation of sexual history, and when documentation was completed, it was often missing important elements, including screening for pregnancy, STI, non-consensual sex, and contraception use. Since the ED visit provides an important opportunity to address the reproductive health needs of this high-risk population, further work is needed to determine ways to improve provider documentation and sexual health screening.

Increasing Adolescent Sexual Activity Screening Through a Provider-Based Intervention

“…Authors found provider screening rates were not associated with gender, age, race, ethnicity, or type of insurance; and this differs from the associated factor findings of Goyal et al (2014). Vayngortin et al (2022) further validate the importance of focusing on ways to enhance provider adherence with screening for sexual activity in healthcare facilities.…”

“…Sexual activity screening has also been investigated among adolescent females with mental health concerns in the emergency room. Vayngortin et al (2022) retrospectively examined sexual history and risk in adolescent females presenting to the emergency department with suicidal ideation. Out of 312 females, aged 13 to 17, only 144 had a documented sexual history.…”

“…Out of 312 females, aged 13 to 17, only 144 had a documented sexual history. This low screening rate was found despite the even higher risk for unintended pregnancy, STIs, risky behaviors, and non-consensual sex in females diagnosed with mental health illness (Vayngortin et al, 2022). Among the adolescents who were screened for sexual history in this study, important elements such as pregnancy screening, STI screening, and contraception use were missing.…”

The evolving role of emergency medicine in family planning services

“…Although some patients may present to the emergency department with an obvious indication for emergency contraception or may request emergency contraception, populations with a higher risk of unprotected intercourse and unintended pregnancy may not routinely be asked. In a recent chart review of a cohort of 13–17 years presenting to the pediatric emergency department with the chief complaint of suicidal ideation, Vayngortin et al [25 ▪ ] reported fewer than half (46.2%) had a documented sexual history but 34.7% reported being sexually active. Of the sexually active patients, only 56% had documentation of contraception use.…”

The Relationship between Maternal Ideation and Exclusive Breastfeeding Practice among Saudi Nursing Mothers: A Cross-Sectional Study

“…The roles of ideation factors in predicting behavior change were examined for cancer care [ 13 ], contraceptive use [ 14 ], suicide [ 15 ], and malaria care [ 16 ], but rarely for breastfeeding in Nigeria [ 11 ]. Examining the predicting role of maternal ideation in EBF practices can help direct and strengthen the cooperation between multidisciplinary healthcare providers in formulating multidisciplinary breastfeeding enhancement strategies.…”