Universal Pediatric Suicide Risk Screening in a Health Care System: 90,000 Patient Encounters

Roaten, Kimberly; Horowitz, Lisa M.; Bridge, Jeffrey A.; Goans, Christian; McKintosh, Chris; Genzel, Russell; Johnson, Celeste; North, Carol S.

doi:10.1016/j.jaclp.2020.12.002

Cited by 33 publications

(25 citation statements)

References 19 publications

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“…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 ). A few papers explored the ASQ's effectiveness in screening younger populations, as young as 8 years old ( 6 , 14 , 20 , 22 , 27 ).…”

Section: Resultsmentioning

confidence: 94%

“…Being Black/African- American was protective in some studies ( 14 , 42 ) and a risk factor in others ( 20 , 22 , 29 ). Those with a positive ASQ result were more likely to be admitted ( 6 , 14 , 22 , 48 ) and more likely to re-present with to the ED ( 6 ), especially with a suicide-related complaint ( 14 , 20 , 27 ). In studies that examined criterion validity, the ASQ had acceptable sensitivity (60-93%) and specificity (43–92%) in predicting future attempts ( 6 , 14 , 20 , 27 , 41 ).…”

Section: Resultsmentioning

confidence: 99%

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

Scudder

Rosin²,

Nelson³

et al. 2022

Front. Psychiatry

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BackgroundAccording to the Centers for Disease Control and Prevention, suicidality and suicidal behavior among youth continues to increase significantly each year. Many of those who die by suicide interact with health services in the year before death. This systematic review sought to identify and describe empirically tested screening tools for suicidality in youth presenting to Emergency Departments (ED).Objective(1) To identify and compare existing tools used to screen for suicidality in children and adolescents who present to the ED and (2) to ascertain the prevalence of suicidality in pediatric populations found with these tools.MethodsWe searched Ovid Medline, CINAHL, Scopus, and Cochrane databases for primary research studies that identified and evaluated screening tools for suicide risk in pediatric ED patients. A total of 7,597 publications published before August 25, 2021 met search criteria and were screened by two independent reviewers based on our inclusion and exclusion criteria, with any conflicts resolved via consensus meetings or an independent reviewer. A total of 110 papers were selected for full text review, of which 67 were excluded upon further inspection. Covidence was used to extract and synthesize results.Results43 articles were eligible for inclusion. Most studies (n = 33) took place in general pediatric EDs; the quality was generally high. Patients ranged from 4-24 years old, with most screening tested in patients 12 years and older. The most researched tools were the Ask-Suicide Screening Questions (ASQ) (n = 15), Columbia-Suicide Severity Rating Scale (C-SSRS) (n = 12), Suicidal Ideation Questionnaire (SIQ) (n = 11), and the Risk of Suicide Questionnaire (RSQ) (n = 7). Where screening was applied to all patients, about one-fifth of pediatric ED patients screened positive; where suicide screening was applied to psychiatric patients only, over half screened positive. Positive screens were more likely to be female and older than negative screens and they were more likely to be assessed and admitted.ConclusionSeveral validated screening tools exist for the purpose of screening pediatric populations in EDs for suicidality. Such tools may help to support early detection and appropriate intervention for youth at risk of suicide.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=276328, identifier: 276328

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Section: Resultsmentioning

confidence: 94%

Section: Resultsmentioning

confidence: 99%

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

Scudder

Rosin²,

Nelson³

et al. 2022

Front. Psychiatry

View full text Add to dashboard Cite

show abstract

“…In a recent retrospective analysis of patients aged 10–17 years given the ASQ ( N = 91,580) across a safety-net public academic healthcare system, an emergency department, and 20 community outpatient clinics, universal screening resulted in 3% of patients being at any risk of suicide and acute positive screens in 1% of patients encounters ( 54 ). One in four patient encounters with a presenting psychiatric complaint resulted in a positive screen while only 2.7% of other encounters did.…”

Section: Screeningmentioning

confidence: 99%

Improving Suicide Prevention in Primary Care for Differing Levels of Behavioral Health Integration: A Review

et al. 2022

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ImportanceSuicide prevention implementation in primary care is needed due to the increasing rate of suicide in the past few decades, particularly for young and marginalized people. Primary care is the most likely point of contact for suicidal patients in the healthcare system. Attention to the level of medical integration with behavioral health is vital to suicide prevention and is applied throughout this review.MethodsA narrative review was performed.ObservationsMany interventions help improve suicide prevention care. PCP education, screening, safety planning/lethal means reduction, care transitions, psychotherapy, and medication management are all evidence-based strategies. Additionally, the pragmatic topics of financing suicide prevention, supporting providers, enacting suicide postvention, and preparing for future directions in the field at each level of primary care/behavioral health integration are discussed.Conclusions and RelevanceThe findings are clinically relevant for practices interested in implementing evidence-based suicide prevention strategies by attending to the behavioral health/medical interface. Leveraging the patient/provider relationship to allow for optimal suicide prevention care requires clinics to structure provider time to allow for emotionally present care. Defining clear roles for staff and giving attention to provider well being are also critical factors to supporting primary care-based suicide prevention efforts.

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“…The days and weeks after hospitalization is a period of particularly high risk for further suicidal behavior and even death by suicide (Crawford, 2004;Knesper, 2010). Although deferring to hospitalization when STB is identified is frequently based in good intentions, most patients expressing suicidal ideation are not at imminent risk (Roaten et al, 2021). Disproportionate responses may contribute to devastating negative effects on youth and young adults.…”

mentioning

confidence: 99%

Disclosure of Youth Suicidality: Views from Lived Experience

Willis-Powell

Fox

Cerel

2022

SpringerBriefs in Psychology

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Insight from individuals with lived experience suggests that unnecessary hospitalization decreases the likelihood that individuals will disclose suicidal thoughts and behaviors to providers. To improve engagement and create better outcomes for individual who experiences a suicidal crisis, clinicians should receive suicide-specific training that emphasizes personalized care for each patient that matches their level of risk. Individualized safety planning and options other than inpatient hospitalization should be prioritized when suicidal thoughts and behaviors are disclosed to providers and when the level of risk does not warrant hospitalization. This will allow youth who make such disclosures to get access to effective and minimally restrictive interventions while preventing trauma and harm. Finally, healthcare systems must focus on investing resources and research into alternatives to inpatient care as treatment for suicidal crises, and individuals with lived experience will be an essential asset to this process.

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Universal Pediatric Suicide Risk Screening in a Health Care System: 90,000 Patient Encounters

Cited by 33 publications

References 19 publications

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

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

Improving Suicide Prevention in Primary Care for Differing Levels of Behavioral Health Integration: A Review

Disclosure of Youth Suicidality: Views from Lived Experience

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