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2009 ; 16
(11
): 1234-41
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Adolescent suicide risk screening in the emergency department
#MMPMID19845554
King CA
; O'Mara RM
; Hayward CN
; Cunningham RM
Acad Emerg Med
2009[Nov]; 16
(11
): 1234-41
PMID19845554
show ga
OBJECTIVES: Many adolescents who die by suicide have never obtained mental health
services. In response to this, the National Strategy for Suicide Prevention
recommends screening for elevated suicide risk in emergency departments (EDs).
This cross-sectional study was designed to examine 1) the concurrent validity and
utility of an adolescent suicide risk screen for use in general medical EDs and
2) the prevalence of positive screens for adolescent males and females using two
different sets of screening criteria. METHODS: Participants were 298 adolescents
seeking pediatric or psychiatric emergency services (50% male; 83% white, 16%
black or African American, 5.4% Hispanic). The inclusion criterion was age 13 to
17 years. Exclusion criteria were severe cognitive impairment, no parent or legal
guardian present to provide consent, or abnormal vital signs. Parent or guardian
consent and adolescent assent were obtained for 61% of consecutively eligible
adolescents. Elevated risk was defined as 1) Suicidal Ideation
Questionnaire-Junior [SIQ-JR] score of > or =31 or suicide attempt in the past 3
months or 2) alcohol abuse plus depression (Alcohol Use Disorders Identification
Test-3 [AUDIT-3] score of > or =3, Reynolds Adolescent Depression Scale-2
[RADS-2] score of > or =76). The Beck Hopelessness Scale (BHS) and Problem
Oriented Screening Instrument for Teenagers (POSIT) were used to ascertain
concurrent validity. RESULTS: Sixteen percent (n = 48) of adolescents screened
positive for elevated suicide risk. Within this group, 98% reported severe
suicide ideation or a recent suicide attempt (46% attempt and ideation, 10%
attempt only, 42% ideation only) and 27% reported alcohol abuse and depression.
Nineteen percent of adolescents who screened positive presented for
nonpsychiatric reasons. One-third of adolescents with positive screens were not
receiving any mental health or substance use treatment. Demonstrating concurrent
validity, the BHS scores of adolescents with positive screens and the POSIT
scores of those with positive screens due to alcohol abuse and depression
indicated substantial impairment. The addition of alcohol abuse with co-occurring
depression as a positive screen criterion did not result in improved case
identification. Among the subgroup screening positive due to depression plus
alcohol abuse, all but one (>90%) also reported severe suicide ideation and/or a
recent suicide attempt. This subgroup (approximately 17% of adolescents who
screened positive) also reported significantly more impulsivity than other
adolescents who screened positive. CONCLUSIONS: The suicide risk screen showed
evidence of concurrent validity. It also demonstrated utility in identifying 1)
adolescents at elevated risk for suicide who presented to the ED with unrelated
medical concerns and 2) a subgroup of adolescents who may be at highly elevated
risk for suicide due to the combination of depression, alcohol abuse,
suicidality, and impulsivity.
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