Brief Suicide Screening Identifies At-Risk Adolescents in Urgent Care

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The second leading cause of death in adolescents is suicide, which accounts for more deaths than cancer, heart disease, and many other causes combined.
The second leading cause of death in adolescents is suicide, which accounts for more deaths than cancer, heart disease, and many other causes combined.

In a study conducted by researchers at the University of Missouri-Kansas City School of Medicine, a brief screening tool to detect suicidal risk effectively identified at-risk adolescents in need of mental health referral.1 The findings were reported in the Archives of Suicide Research.

The second leading cause of death in adolescents is suicide, which accounts for more deaths than cancer, heart disease, and many other causes combined.2 Previous studies have revealed that 17% of high school students had seriously considered suicide and 8% had attempted suicide over a 12-month period, and that many adolescents in need of help are not accessing mental health services.3,4   

Other research has found that “up to 80% of youth who died by suicide had visited a healthcare provider, either an outpatient provider or in the emergency room, in the year prior to their death,” wrote Aimy T. Patel, MD, from Children's Mercy Urgent Care-Northland, Kansas City, Missouri, and colleagues.5 This suggests that universal screening to detect suicidal risk in such non-mental health care settings could help identify at-risk patients who may otherwise be overlooked.

To that end, the investigators incorporated a brief suicide screening tool into the regular intake process at a pediatric urgent care clinic. The screening consisted of 2 questions:

  1. In the past week including today, have you felt like life is NOT worth living?
  2. In the past week including today, have you wanted to kill yourself?

A total of 4786 patients (56% female; 13% black, 68% white) aged 12 to 19 were screened. A final sample of 95 patients answered affirmatively to one or both questions on the suicide screener, prompting a psychological evaluation by a social worker that included the Columbia-Suicide Severity Rating Scale (C-SSRS).

The C-SSRS assesses 4 main components of suicidal ideation and behavior with the severity subscale, intensity of ideation subscale, behavior subscale, and the lethality subscale. In the present study, the C-SSRS was deemed positive if the severity and/or behavior subscale was positive. “The social worker, family, and urgent care team then collaborated to recommend the patient's disposition, potentially including referral for outpatient psychiatric care or for inpatient psychiatric admission,” the researchers wrote.

The 95 patients who answered affirmatively had a mean age of 14 years (standard deviation [SD] 1.7), and 70% were female. In addition, the following observations were noted:

  • 79% of patients had a positive C-SSRS
  • Only 7% of patients had chief complaints related to mental health
  • 82% of patients were discharged with referral to outpatient mental health services
  • 10% of patients were admitted to a psychiatric facility

These results demonstrate that a brief screening tool can “adequately identify patients at risk of suicide without significantly interrupting the flow of the acute care setting,” the investigators concluded.

References

  1. Patel A, Watts C, Shiddell S, et al. Universal adolescent suicide screening in a pediatric urgent care center [published online March 10, 2017]. Arch Suicide Res. 1-10. doi:10.1080/13811118.2017.1304303
  2. Centers for Disease Control and Prevention. Injury prevention and control: Data and statistics; Web-based injury statistics query and reporting system (WISQARS). www.cdc. gov/injury/wisqars/facts.html. Accessed 4/28/17.
  3. Kann L, Kinchen S, Shanklin SL, et al; Centers for Disease Control and Prevention (CDC): Youth risk behavior surveillance–United States, 2013. MMWR Surveillance Summaries. 2013;63:1-168.
  4. Husky MM, McGuire L, Flynn L, Chrostowski C, Olfson M. Correlates of help-seeking behavior among a-risk adolescents. Child Psychiatr Human Develop. 2009;40(1):15-24. doi:10.1007/s10578-008-0107-8
  5. Rhodes AE, Khan S, Boyle, MH, et al. Sex differences in suicides among children and youth: The potential impact of help-seeking behavior. Canadian J Psychiatry. 2013;58(5):274-282. doi:10.1177/ 070674371305800504
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