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Assessment of Selective and Universal Screening for Suicide Risk in a Pediatric Emergency Department
Open accessAbstract
Importance: According to National Patient Safety Goal 15.01.01, all individuals being treated or evaluated for behavioral health conditions as their primary reason for care in hospitals and behavioral health care organizations accredited by The Joint Commission should be screened for suicide risk using a validated tool. Existing suicide risk screens have minimal or no high-quality evidence of association with future suicide-related outcomes. Objective: To test the association between results of the Ask Suicide-Screening Questions (ASQ) instrument in a pediatric emergency department (ED), implemented through selective and universal screening approaches, and subsequent suicide-related outcomes. Design, Setting, and Participants: In this retrospective cohort study at an urban pediatric ED in the United States, the ASQ was administered to youths aged 8 to 18 years with behavioral and psychiatric presenting problems from March 18, 2013, to December 31, 2016 (selective condition), and then to youths aged 10 to 18 years with medical presenting problems (in addition to those aged 8-18 years with behavioral and psychiatric presenting problems) from January 1, 2017, to December 31, 2018 (universal condition). Exposure: Positive ASQ screen at baseline ED visit. Main Outcomes and Measures: The main outcomes were subsequent ED visits with suicide-related presenting problems (ie, ideation or attempts) based on electronic health records and death by suicide identified through state medical examiner records. Association with suicide-related outcomes was calculated over the entire study period using survival analyses and at 3-month follow-up for both conditions using relative risk. Results: The complete sample was 15 003 youths (7044 [47.0%] male; 10 209 [68.0%] black; mean [SD] age, 14.5 [3.1] years at baseline). The follow-up for the selective condition was a mean (SD) of 1133.7 (433.3) days; for the universal condition, it was 366.2 (209.2) days. In the selective condition, there were 275 suicide-related ED visits and 3 deaths by suicide. In the universal condition, there were 118 suicide-related ED visits and no deaths during the follow-up period. Adjusting for demographic characteristics and baseline presenting problem, positive ASQ screens were associated with greater risk of suicide-related outcomes among both the universal sample (hazard ratio, 6.8 [95% CI, 4.2-11.1]) and the selective sample (hazard ratio, 4.8 [95% CI, 3.5-6.5]). Conclusions and Relevance: Positive results of both selective and universal screening for suicide risk in pediatric EDs appear to be associated with subsequent suicidal behavior. Screening may be a particularly effective way to detect suicide risk among those who did not present with ideation or attempt. Future studies should examine the impact of screening in combination with other policies and procedures aimed at reducing suicide risk.
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“Studies show the ASQ has high sensitivity, specificity, and negative predictive validity, and that it can detect patients at risk for suicide that depression screening alone fails to identify.40-42”
From Evidence-based youth suicide prevention and intervention in pediatric primary care settings. (2024) · cites this paper as [42]
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Suicide and Suicide Risk in Adolescents
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Screening pediatric medical patients for suicide risk: Is depression screening enough?
Horowitz, L. M., Mournet, A. M., Lanzillo, E., He, J.-P., Powell, D. S., Ross, A. M., Wharff, E. A., Bridge, J. A., & Pao, M. (2021) · Journal of Adolescent Health · doi:10.1016/j.jadohealth.2021.01.028 · Cited by 78
Prospective Development and Validation of the Computerized Adaptive Screen for Suicidal Youth
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Self-citationValidation and Feasibility of the ASQ Among Pediatric Medical and Surgical Inpatients
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Metadata
- Authors
- DeVylder, J. E., Ryan, T. C., Cwik, M., Wilson, M. E., Jay, S., Nestadt, P. S., Goldstein, M., & Wilcox, H. C.
- Affiliations
- Fordham University (US)
- Johns Hopkins University (US)
- University of Maryland, Baltimore County (US)
- Corresponding author
- Wilcox, Holly C.
- Venue
- JAMA Network Open
- Publisher
- American Medical Association (AMA)
- Published
- 2019-10-25
- Volume
- 2
- Issue
- 10
- Pages
- e1914070
- ISSN
- 2574-3805 (ISSN-L)
- PMC
- PMC6822088
- OpenAlex
- W2981677884
- Cited by
- 109
- References
- 23
- Citations by year
- 2026: 7 · 2025: 25 · 2024: 15 · 2023: 20 · 2022: 16 · 2021: 18 · 2020: 7 · 2019: 1
- FWCI
- 12.26
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- JAMA Network Open (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- U.S. Department of Health and Human Services
- American Foundation for Suicide Prevention (YIG-1-042-16)
- Substance Abuse and Mental Health Services Administration (U79SM061751)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
- Social Sciences › Health › Gun Ownership and Violence Research
- Keywords
- suicide risk screening, Ask Suicide-Screening Questions, ASQ, pediatric emergency department, universal screening, targeted screening, suicide attempts, suicidal ideation, suicide mortality, adolescents, suicide prevention, National Patient Safety Goals, behavioral health, screening tool validation, hospital accreditation, Joint Commission, electronic health records
- MeSH terms
- Suicide Prevention, Adolescent, Child, Emergency Service, Hospital, Female, Humans, Male, Mass Screening, Risk Factors, Suicide, Attempted, Risk Assessment, Suicidal Ideation
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