Suicide screening

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Screening

The United States Preventive Services Task Force (USPSTF) have declared that there is insufficient evidence to determine the benefits of screening for suicide risk in the general population of United States adolescents having no prioe history of mental disorders or previous suicide attempts.

Primary care

• Direct questioning: Screening adolescents for suicidal ideation by directly asking about it in the context of screening for depression (Practice guidelines from the American Academy of Pediatrics)
• Patient Health Questionnaire (PHQ-9): A self-report screening tool, such as the nine-item Patient Health Questionnaire (PHQ-9) modified for teens, which screens for depression and as such, includes one item that asks about suicidal ideation.
• Screening for depression

Emergency department — For youth evaluated in the emergency department by non-mental health clinicians, a brief screening tool may have some value in identifying risk for suicidal behavior. The Ask Suicide-Screening Questions is a four-item instrument that clinicians can administer to screen for risk of suicide in patients who present to pediatric emergency departments with psychiatric or general medical complaints [10]. The four items are:

●In the past few weeks, have you wished you were dead?

●In the past few weeks, have you felt that you or your family would be better off if you were dead?

●In the past week, have you been having thoughts about killing yourself?

●Have you ever tried to kill yourself?

Answering yes to at least one question constitutes a positive screen that should trigger a more extensive evaluation of the patient’s risk for suicide. (See 'Risk assessment of suicidal ideation' below.)

A cross-sectional study in patients aged 10 to 21 years who presented to pediatric emergency departments with psychiatric (n = 180) or general medical (n = 344) problems found that the Ask Suicide-Screening Questions had good psychometric properties [10]. Sensitivity was 97 percent and specificity 88 percent. In psychiatric patients, the positive and negative predictive values were 71 and 97 percent; in general medical patients, positive and negative predictive values were 39 and 100 percent. A limitation of the study was that it was cross-sectional rather than assessing true predictive ability.

A systematic review found that two other screening instruments for suicidal ideation or behavior in high risk adolescents performed poorly [8].