Suicide Risk Screening in Pediatric Outpatient Neurodevelopmental Disabilities Clinics

Abstract

Objective: The purpose of this study was to describe the implementation of universal suicide risk screening in pediatric neurodevelopmental disabilities (NDD) medical clinics, analyze demographic and clinical characteristics of eligible patients, describe outcomes of positive screenings, and describe factors that influenced participation in screenings. Methods: A suicide risk screening protocol was developed and implemented for medical clinic patients aged 8 to 18 years. Registered nurses screened patients using the "Ask Suicide-Screening Questions" tool during triage. Positive screenings were referred for further assessment and mental health management. Demographics and clinical data were extracted from medical records using retrospective chart reviews. Results: During the 6-month study period, 2961 individual patients presented for 5260 screening eligible patient visits. In total, 3854 (73.3%) screenings were completed with 261 (6.8%) positive screenings noted. Screenings were declined in 1406 (26.7%) visits. Parents of children with cognitive impairments were more likely to decline screening. Clinics serving children with autism spectrum disorder had higher rates of positive screenings compared with all other clinic attendees. Seventy-two of 187 children (38.5%) with positive screenings were identified and referred to outpatient mental health referrals. Seven (2.5%) of these children required acute psychiatric treatment. Conclusion: Routine screening, identification of increased suicide risk, and referral to mental health care among children with NDD are feasible. It remains unclear whether variation in rates among youth with and without NDD may indicate true differences in suicide risk or cognitive impairments or reflect psychiatric comorbidities. High rates of declined participation may have influenced identification of children with NDD and suicide risk. Preliminary findings identified groups of children with NDD at heightened risk for suicidal ideation and behavior. Further research is needed to assess the validity of suicide risk screening tools in children with neurodevelopmental disorders.

Suicide in young people: screening, risk assessment, and intervention

“…Screening for suicide risk involves use of an evidence based, standardized screening measure to identify young people with suicidal ideation or behavior and can be accomplished at the universal, selective, or indicated level. Clinical screening may occur in the emergency department,596061 inpatient and acute care hospital settings,626364 specialty behavioral health, primary care,65 and specialty medical clinics such as sports medicine,66 adolescent medicine, child abuse clinics,67 and/or school based clinics or the school nurse’s office. Using a specific suicide risk screening instrument is recommended, as general mental health or depression screens often under-detect young people experiencing suicidal ideation 686970.…”

Neurodevelopmental Disorders and Suicide: A Narrative Review

“…Unfortunately, the current literature does not yet provide answers to these questions. However, recent research [ 16 ] describes the results of a 6 month study of a population with NDDs (aged 8 to 18 years) screened by nurses using the “Ask Suicide-Screening Questions” tool during triage. A high percentage (73.3%) of screenings were completed for 3854 individuals, with 261 positive screenings noted (6.8%).…”

“…According to this paradigm, there is evidence that universal suicide risk screening implementation in pediatric NDDs in order to identify increased suicide risk and referral to mental health care is feasible and potentially extremely useful, although the high rates of declined participation that previous experiences have highlighted further underline how great the social stigma is related to the suicidal phenomenon [ 16 ].…”

The Suicidal Ideation Attributes Scale-Modified (SIDAS-M): Development and preliminary validation of a new scale for the measurement of suicidal ideation in autistic adults

“…Indeed, the Joint Commission now calls for all people to be screened for suicidal ideation using a validated screening tool as a means of suicide prevention (NPSG.15.01.01; The Joint Commission, 2022). In a recent study, Rybczynski et al (2022) demonstrated the feasibility of routine suicide risk screening in pediatric neurodevelopmental disability clinics, with higher rates of positive screenings identified for children diagnosed with autism than other patients. Children who screened positive were referred to outpatient mental health centers with a small number requiring acute psychiatric care.…”