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Feasibility of Screening Patients With Nonpsychiatric Complaints for Suicide Risk in a Pediatric Emergency Department

Lisa M. Horowitz · Elizabeth D. Ballard · Stephen J. Teach · Abigail Bosk · Donald Lee Rosenstein · Paramjit T. Joshi +2 more

90 citations0/0 files storedPediatric Emergency Care

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Suicide and Self-Harm Studies Emergency and Acute Care Studies Gun Ownership and Violence Research

Abstract

OBJECTIVE: Screening children for suicide risk when they present to the emergency department (ED) with nonpsychiatric complaints could lead to better identification and treatment of high-risk youth. Before suicide screening protocols can be implemented for nonpsychiatric patients in pediatric EDs, it is essential to determine whether such efforts are feasible. METHODS: As part of an instrument validation study, ED patients (10-21 years old) with both psychiatric and nonpsychiatric presenting complaints were recruited to take part in suicide screening. Clinically significant suicidal thoughts, as measured by the Suicidal Ideation Questionnaire, and suicidal behaviors were assessed, as well as patient opinions about suicide screening. Recruitment rates for the study as well as impact on length of stay were assessed. RESULTS: Of the 266 patients and parents approached for the study, 159 (60%) agreed to participate. For patients entering the ED for nonpsychiatric reasons (n = 106), 5.7% (n = 6) reported previous suicidal behavior, and 5.7% (n = 6) reported clinically significant suicidal ideation. There were no significant differences for mean length of stay in the ED for nonpsychiatric patients with positive triggers and those who screened negative (means, 382 [SD, 198] and 393 [SD, 166] minutes, respectively; P = 0.80). Ninety-six percent of participants agreed that suicide screening should occur in the ED. CONCLUSIONS: Suicide screening of nonpsychiatric patients in the ED is feasible in terms of acceptability to parents, prevalence of suicidal thoughts and behaviors, practicality to ED flow, and patient opinion. Future endeavors should address brief screening tools validated on nonpsychiatric populations.

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References

2002Contact With Mental Health and Primary Care Providers Before Suicide: A Review of the Evidence 2005Evaluating Iatrogenic Risk of Youth Suicide Screening Programs 2003Attendance at the accident and emergency department in the year before suicide: Retrospective study 2005National Study of US Emergency Department Visits for Attempted Suicide and Self-Inflicted Injury, 1997-2001 1992Suicidal Ideation Questionnaire 2009Suicide screening in schools, primary care and emergency departments 2004Level of suicidal intent predicts overall mortality and suicide after attempted suicide: a 12-year follow-up study 2001Detecting Suicide Risk in a Pediatric Emergency Department: Development of a Brief Screening Tool

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2016Reducing Suicide Risk: Challenges and Opportunities in the Emergency Department 2015Comparison of Electronic Screening for Suicidal Risk With the Patient Health Questionnaire Item 9 and the Columbia Suicide Severity Rating Scale in an Outpatient Psychiatric Clinic 2020What’s the harm in asking? A systematic review and meta-analysis on the risks of asking about suicide-related behaviors and self-harm with quality appraisal

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