Asking Youth Questions About Suicide Risk in the Pediatric Emergency Department: Results From a Qualitative Analysis of Patient Opinions

doi:10.1016/j.cpem.2013.01.001

Clinical Pediatric Emergency Medicine

Volume 14, Issue 1, March 2013, Pages 20-27

https://doi.org/10.1016/j.cpem.2013.01.001 Get rights and content

The emergency department (ED) is a promising setting to screen youth for suicide risk. Patient reactions to questions about suicidal thoughts and behaviors during their ED visit have implications for how screening is introduced, developed, and implemented. The current study is a qualitative investigation into patient opinions about screening for suicide risk in the ED. As part of a subset of a multisite study, 165 participants, 10 to 21 years old, were included in this subanalysis. Ninety percent of participants supported suicide risk screening. Reasons youth supported screening included prevention of suicide, detection of at-risk youth, and lack of other social support. Overall, pediatric patients agreed with suicide risk screening in the ED. A small subset of youth (10%) did not support screening for reasons that included a desire to focus on their chief presenting concern and fear of iatrogenic risk. Understanding patient opinions, including those in support of and in opposition to screening, can inform implementation practices. Further education about the importance of suicide risk assessment may be a helpful first step in instituting universal screening efforts.

Section snippets

Participant Population

These data were collected as part of a multisite study that developed and validated a suicide risk screening instrument, the Ask Suicide-Screening Questions (ASQ), for pediatric EDs.³ Participants were part of a convenience sample of ED patients, aged 10 to 21 years, inclusive, seeking care at Nationwide Children's Hospital, which is an urban pediatric ED associated with a tertiary care teaching hospital and has an annual census of more than 79 000 visits. Study enrollment occurred between

Results

During the study period, 170 (63%) of the 271 eligible patients approached in the pediatric ED agreed to participate. Three participants had missing data for the question of interest (ie, “Do you think ER nurses should ask kids about suicide/thoughts about hurting themselves…why/why not?”). Two additional participants answered with “I don't know,” limiting qualitative inquiry. Thus, the sample for the current study consists of 165 patients. Demographic data are presented in Table 1.

Consistent

Discussion

Most pediatric ED patients presenting with psychiatric and nonpsychiatric complaints supported universal screening for suicide risk. After qualitative analysis of youth opinions about screening, 5 top themes emerged: detection and identification of suicide risk, prevention, mental health resource linkage, lack of other outlets for social support, and a desire to be understood. These themes were similar to those found in a previous study using opinions from another pediatric ED sample with

Conclusion

Pediatric ED patients support universal suicide risk screening. With thoughtful and careful implementation, screening can provide youth the opportunity to speak with a trusted clinician about distressing thoughts. In turn, nonpsychiatric clinicians can link young patients with needed mental health resources. Conceivably, such a bridge can prevent suicidal behavior and related ED visits in the future. In the words of one 16-year-old psychiatric participant, who presented to the ED with suicidal

Acknowledgment

The research in this article was supported by the Intramural Research Program of the National Institutes of Health and the National Institute of Mental Health. Dr Bridge was supported by institutional research funds from The Research Institute at Nationwide Children's Hospital, CDC grant R01 CE-002129, and NIMH grants K01 MH-69948 and R01 MH-93552.

The opinions expressed in the article are the views of the authors and do not necessarily reflect the views of the Department of Health and Human

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Identifying Suicide Risk in Adolescents With Firearm Access: Screening in the Emergency Department
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This study compares current suicidal ideation, prior suicide attempt and associated self-reported risk factors in adolescents with and without access to firearms.
Using data from a clinically applied behavioral health assessment completed by adolescents presenting to a tertiary children's hospital emergency department (ED; N = 15,806), we evaluated the association between firearm access (ie, firearm in the home or ability to obtain one within 24 hours), each of the included suicide risk factors (ie, depressive symptoms, trauma victimization, bullying victimization), and our primary outcomes (ie, current suicidal ideation and prior suicide attempt). We performed regression analyses on 3 groups: 1) The overall population; 2) Only the participants with firearm access; and 3) Only the participants without firearm access.
Fourteen percent (2179/15,806) of the sample reported a firearm in the home or ability to access one within 24 hours. Overall, 6.8% of participants reported current suicidal ideation and 9.1% reported prior suicide attempt. Youth with firearm access had 1.52 times higher odds of current suicidal ideation and 1.61 times higher odds of prior suicide attempt compared to youth without firearm access. All included suicide risk factors were found to significantly increase the odds of current suicidal ideation and prior suicide attempt in the overall sample; this increase was similar in the groups with and without firearm access.
Adolescents with firearm access have higher odds of suicidal ideation and prior attempt compared to those without firearm access, highlighting the need for universal ED-based screening for suicidality and lethal means.
Implementing Suicide Risk Screening in a Pediatric Primary Care Setting: From Research to Practice
2022, Academic Pediatrics
To describe the methodological development and feasibility of real-world implementation of suicide risk screening into a pediatric primary care setting.
A suicide risk screening quality improvement project (QIP) was implemented by medical leadership from a suburban-based pediatric (ages 12–25 years) primary care practice in collaboration with a National Institute of Mental Health (NIMH) suicide prevention research team. A pilot phase to acclimate office staff to screening procedures preceded data collection. A convenience sample of 271 pediatric medical outpatients was screened for suicide risk. Patients, their parents, and medical staff reported their experiences and opinions of the screening procedures.
Thirty-one (11.4%) patients screened positive for suicide risk, with 1 patient endorsing imminent suicide risk (3% of positive screens; 0.4% of total sample). Over half of the patients who screened positive reported a past suicide attempt. Most patients, parents, and medical staff supported the implementation of suicide risk screening procedures into standard care. A mental health clinical pathway for suicide risk screening in outpatient settings was developed to provide outpatient medical settings with guidance for screening.
Screening for suicide risk in pediatric primary care is feasible and acceptable to patients, their families, and medical staff. A clinical pathway used as guidance for pediatric health care providers to implement screening programs can aid with efficiently detecting and managing patients who are at risk for suicide.
Universal suicide risk screening: Views of rural adults on acceptability and implementation in primary care
2021, General Hospital Psychiatry
Citation Excerpt :
These findings are likely to be reassuring to health care providers, who often report anxiety with regard to screening for suicide risk [38]. Collectively, study findings suggest that universal suicide risk screening is valued and well-received by adult patients in rural primary care, echoing findings from previous studies of patient opinions in urban settings [17–22]. These are encouraging results given the high levels of stigma that typically surround mental health care-seeking in rural communities [5,7,23], and support the feasibility of future research and implementation of suicide prevention efforts in rural communities.
This study gathered data from rural adult primary care patients regarding the acceptability of universal suicide risk screening and preferred methods of implementation.
Patients from a rural primary care clinic in southern West Virginia participating in a pilot test of a suicide risk screening program were administered a Screening Opinions Survey and resulting data were evaluated using descriptive and content analyses.
The majority of participants (96%) believed that primary care providers (PCPs) should screen patients for suicide and noted multiple benefits to screening. Most participants described the experience of screening in primary care as positive or neutral and preferred a personalized screening process where the provider asked questions directly. Demographic analyses indicated that males and older adults were less likely to report being previously screened for suicide and that older adults were less likely to support the practice of screening.
Results provide support for the acceptability of universal suicide risk screening programs to patients in rural primary care and suggest that PCP involvement in the screening process may encourage patient participation. Additional training for PCPs and psychoeducational interventions for older adults may help to address demographic influences on screening practices and engagement.
The Feasibility and Impact of a Suicide Risk Screening Program in Rural Adult Primary Care: A Pilot Test of the Ask Suicide-Screening Questions Toolkit
2020, Psychosomatics
Citation Excerpt :
Although it is important to note that 40% of the total intervention sample were not surveyed about their views regarding PCP screening, it is still encouraging that the majority of those who were surveyed endorsed the practice of screening in primary care. These findings in a rural, adult ambulatory primary care setting are consistent with findings from other empirical studies that suicide risk screening is feasible and acceptable to most patients, including those in inpatient adult medical units, pediatric emergency rooms, and urban adult primary care.12–16,29 Given the high levels of stigma associated with mental health help-seeking in rural areas,21 it is reassuring that a significant proportion of patients in this rural Appalachian primary care setting agreed to suicide risk screening with a standardized measure.
The purpose of this study was to evaluate the feasibility and impact of a suicide risk screening program in a rural West Virginia primary care practice.
Patients presenting for routine and sick visits were asked to participate in electronic suicide risk screening using the Ask Suicide-Screening Questions tool; screen positive individuals were assessed with the Ask Suicide-Screening Questions Brief Suicide Safety Assessment. Screening program feasibility was evaluated by the proportion of patients consenting to participate, participant Ask Suicide-Screening Questions and Brief Suicide Safety Assessment completion rates, and response to a question asking whether primary care providers should ask about suicide. Screening impact was evaluated quasi-experimentally by comparing electronic medical record documentation of suicide risk screening, assessment, and risk determination in practice patients before and after implementing the screening program.
Over half of the patients approached agreed to participate in a research study about suicide (N = 196; 57.7%). Feasibility of the screening program was demonstrated by the high completion rates for the Ask Suicide-Screening Questions (99.0%) and the Brief Suicide Safety Assessment (100.0%) among study participants. Additionally, 95.4% (N = 187) of participants agreed primary care providers should screen patients for suicide. Suicide screening rates rose significantly between the baseline and intervention phases (5.8% to 61.0%; X² = 200.61, P < 0.001), as did suicide risk detection rates (0.7% to 6.2%; X² = 12.58, P < 0.001).
Suicide risk screening was feasible and well accepted by adult patients in rural primary care and has potential to improve suicide risk detection in this setting.

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Asking Youth Questions About Suicide Risk in the Pediatric Emergency Department: Results From a Qualitative Analysis of Patient Opinions

Section snippets

Participant Population

Results

Discussion

Conclusion

Acknowledgment

Adolescent suicide risk screening in the emergency department

Acad Emerg Med

Screening for suicide risk in the pediatric emergency and acute care setting

Curr Opin Pediatr

Ask suicide-screening questions (ASQ): a brief instrument for the pediatric emergency department

Arch Pediatr Adolesc Med

Youth risk behavior surveillance—United States

2012 national strategy for suicide prevention: goals and objectives for action

American Association of Suicidology & Suicide Prevention Resource Center. Continuity of care for suicide prevention and research: suicide attempts and suicide deaths subsequent to discharge from the emergency department or psychiatry inpatient unit

Screening as an approach for adolescent suicide prevention

Suicide Life Threat Behav