Adolescent Suicide—Understanding Unique Risks and Opportunities for Trauma Centers to Recognize, Intervene, and Prevent a Leading Cause of Death

May combine two claims.

Lethal means counseling, secure firearm storage, and firearm safety policies can reduce suicide risk.

“Lethal means counseling, secure firearm storage practices, and firearm safety policies can reduce the risk of suicide.”

• cites [26] Fowler KA, Dahlberg LL, Haileyesus T, Annest JL. Firearm injuries in the United States. Prev Med. 2015;79:5–14. https://doi.org/10.1016/j.ypmed.2015.06.002. sourcePartly supported

  The Discussion (page unavailable) says that restricting access to a highly lethal method can matter during a suicidal crisis, supporting the general rationale for reducing firearm access. It mentions safe storage in relation to unintentional injuries among children, but does not establish that lethal means counseling, secure storage, or firearm safety policies reduce suicide risk. (LLM, conf=0.86)

  Experimental — accuracy not yet measured
• cites [27] Grossman DC, Mueller BA, Riedy C, et al. Gun storage practices and risk of youth suicide and unintentional firearm injuries. JAMA. 2005;293(6):707–14. sourceNot checked — no full text of the source
• cites 28•Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

Certain mental health disorders, history of suicide behaviors (ideation, attempts), and NSSI significantly increase suicide risk.

“Certain mental health disorders and a history of suicide behaviors (ideation, attempts) and non-suicidal self-injury (NSSI) significantly increase risk [7••, 11].”

• cites 7••Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites [11] Mars B, Heron J, Klonsky ED, Moran P, O’Connor RC, Tilling K, Wilkinson P, Gunnell D. Predictors of future suicide attempt among adolescents with suicidal thoughts or non-suicidal self-harm: a population-based birth cohort study. Lancet Psychiatry. 2019;6(4):327–37. https://doi.org/10.1016/S2215-0366(19)30030-6. sourcePartly supported

  The Introduction describes suicidal thoughts and non-suicidal self-harm as strong predictors of suicide attempts, and the Results find that non-suicidal self-harm predicted first attempts among adolescents with suicidal thoughts. But the Discussion says this study found no evidence that psychiatric disorders predicted the transition to an attempt, and people with previous attempts were excluded. The source therefore does not support the claim about mental disorders or prior attempts as stated. (LLM, conf=0.90)

  Experimental — accuracy not yet measured

May combine two claims.

Adolescents with suicidal thoughts and behaviors account for 26% of future suicide attempts by age 26 and are strongly associated with suicide death.

“Although most adolescents that have suicidal thoughts and behaviors do not progress to suicide attempts, they account for 26% of future suicide attempts by the age of 26 and they are strongly associated with suicide death [11].”

• cites [11] Mars B, Heron J, Klonsky ED, Moran P, O’Connor RC, Tilling K, Wilkinson P, Gunnell D. Predictors of future suicide attempt among adolescents with suicidal thoughts or non-suicidal self-harm: a population-based birth cohort study. Lancet Psychiatry. 2019;6(4):327–37. https://doi.org/10.1016/S2215-0366(19)30030-6. sourcePartly supported

  The Discussion reports that adolescents with both suicidal thoughts and non-suicidal self-harm accounted for approximately a quarter of participants who attempted suicide during follow-up. The Results place follow-up at age 21, not 26, and the paper does not establish an association with suicide death. The reported share also concerns adolescents with both characteristics, not all adolescents with suicidal thoughts or behaviors. (LLM, conf=0.90)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing).

5.1% of male and 9.3% of female US high school students report a suicide attempt in the past year.

“The incidence has been steadily rising in the USA, and 5.1% of male and 9.3% of female high school students in the USA report a suicide attempt in the past year [2].”

• cites [2] Kann L, McManus T, Harris WA, Shanklin SL, Flint KH, Queen B, et al. Youth Risk Behavior Surveillance - United States, 2017. MMWR Surveill Summ. 2018;67(8):1–114. https://doi.org/10.15585/mmwr.ss6708a1. sourcePartly supported

  The Results section, under “Attempted Suicide,” reports that 5.1% of male and 9.3% of female students had attempted suicide during the 12 months before the survey. The same section does not support the citing sentence’s claim of a steady rise: it reports a significant linear decrease over 1991–2017 and no significant change from 2015 to 2017. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

May combine two claims.

Persistent opioid prescriptions and substance use disorders are high 4 years after traumatic injury.

“Of high school students reporting opioid misuse, 80% reported they were initially prescribed to them by a physician, and persistent opioid prescriptions and substance use disorders are high 4 years after traumatic injury [51, 52].”

• cites [51] McCabe SE, West BT, Teter CJ, Boyd CJ. Medical and nonmedical use of prescription opioids among high school seniors in the United States. Arch Pediatr Adolesc Med. 2012;166(9):797–802. sourceCould not verify

  The Results section reports substance-use behaviors among high school seniors with different histories of prescription-opioid use. Neither it nor the other passages found by searching for traumatic injury and four-year follow-up addresses persistent prescriptions or substance use disorders four years after injury. (LLM, conf=0.77)

  Experimental — accuracy not yet measured
• cites [52] Bell TM, Raymond J, Vetor A, Mongalo A, Adams Z, Rouse T, Carroll A. Long-term prescription opioid utilization, substance use disorders, and opioid overdoses after adolescent trauma. J Trauma Acute Care Surg. 2019;87(4):836–40. sourcePartly supported

  The Results report persistent opioid prescriptions at four years: over 13% of the adolescent trauma cohort had more than eight fills, with at least two new fills per year. They report SUD diagnoses in 14% over five years, but do not establish that SUD diagnoses were high specifically at four years. (LLM, conf=0.87)

  Experimental — accuracy not yet measured

May combine two claims.

Some adolescents with depression may have difficulty verbalizing feelings or may deny being depressed or suicidal.

“Notably, some adolescents with depression may have difficulty in verbalizing their feelings or may deny that they are depressed or suicidal.”

• cites [54] Birmaher B, Brent D. AACAP Work Group on Quality Issues Practice parameter for the assessment and treatment of children and adolescents with depressive disorders. J Am Acad Child Adolesc Psychiatry. 2007;46(11):1503–26. https://doi.org/10.1097/chi.0b013e318145ae1c. sourcePartly supported

  Evaluation Recommendation 3 says children may have difficulty verbalizing their feelings or may deny being depressed, in the context of assessing children and adolescents. The paper recommends assessing suicidality in Recommendation 4, but the passages do not say that adolescents may deny being suicidal; that part of the claim is unsupported. (LLM, conf=0.86)

  Experimental — accuracy not yet measured

May combine two claims.

Surviving a violent injury and exposure to violence from IPV and community firearm violence increases risk of suicidal ideation.

“Surviving a violent injury, and exposure to violence from IPV and community firearm violence, increases the risk of suicidal ideation [48, 49].”

• cites [48] Hsu HT, Fulginiti A, Petering R, Barman-Adhikari A, Maria DS, Shelton J, Bender K, Narendorf S, Ferguson K. Firearm violence exposure and suicidal ideation among young adults experiencing homelessness. J Adolesc Health. 2020;67(2):286–9. https://doi.org/10.1016/j.jadohealth.2020.02.018. sourcePartly supported

  The Results (page not available) associate firearm violence perpetration with higher odds of suicidal ideation among young adults experiencing homelessness. They also state that direct and indirect gun-violence victimization were not associated with suicidal ideation. Thus the paper does not support the sentence’s broad claim about exposure to community firearm violence increasing risk; it establishes an association for perpetration, not a causal increase for all forms of exposure. (LLM, conf=0.88)

  Experimental — accuracy not yet measured
• cites [49] Smith ME, Sharpe TL, Richardson J, Pahwa R, Smith D, DeVylder J. The impact of exposure to gun violence fatality on mental health outcomes in four urban US settings. Soc Sci Med. 2020;246:112587. https://doi.org/10.1016/j.socscimed.2019.112587. sourcePartly supported

  The Results section (“Secondary Exposure to Gun Violence Fatality and Mental Health Outcomes”) reports higher odds of suicidal ideation among respondents who knew someone who died from gun violence (OR 1.95). The paper does not establish that surviving a violent injury or exposure to IPV increases that risk, and its observational association does not establish causation. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

May combine two claims.

TBI suicide risk increases with TBI severity, long hospitalizations, and frequent medical encounters.

“Suicide risk is well established for traumatic brain injury in children and adults, as suicide rates among individuals with a history of TBI are twice that of those who have not experienced TBI, and the risk is increased with TBI severity, long hospitalizations, and frequent medical encounters [38].”

• cites [38] Madsen T, Erlangsen A, Orlovska S, Mofaddy R, Nordentoft M, Benros ME. Association between traumatic brain injury and risk of suicide. JAMA. 2018;320(6):580–8. https://doi.org/10.1001/jama.2018.10211. sourceSupported

May combine two claims.

Some studies indicate increased risk of suicide attempts and completion with media coverage of suicides in a community and when adolescents learn of schoolmates' suicides.

“The concept of suicide as a contagion among children has garnered significant interest, and some studies indicate increased risk of attempts and completion with media coverage of suicides in a community, and when adolescents learn of suicides of schoolmates [29–31].”

• cites [29] Gould MS, Kleinman MH, Lake AM, Forman J, Midle JB. Newspaper coverage of suicide and initiation of suicide clusters in teenagers in the USA, 1988–96: a retrospective, population-based, case-control study. Lancet Psychiatry. 2014;1(1):34–43. sourceNot checked — no full text of the source
• cites [30] Hawton K, Hill NT, Gould M, John A, Lascelles K, Robinson J. Clustering of suicides in children and adolescents. Lancet Child Adolesc Health. 2020;4:58–67. sourceNot checked — no full text of the source
• cites [31] Swanson SA, Colman I. Association between exposure to suicide and suicidality outcomes in youth. CMAJ. 2013;185(10):870–7. sourcePartly supported

  The Results report increased odds of suicide attempts among adolescents exposed to a schoolmate’s suicide. The Abstract also reports ecological evidence that suicide rates rise after a highly publicized suicide. But the Strengths and limitations section says this study did not measure media exposure, and it did not assess completed suicides among the adolescents; the source therefore does not support both outcomes for both forms of exposure. (LLM, conf=0.86)

  Experimental — accuracy not yet measured

May combine two claims.

Family, home, and social support risk factors include parental mental health problems or suicide history, poor parent-child relationships, unsupportive parental/school beliefs for LGBTQ youth, social isolation, housing insecurity, and living in corrections or residential facilities.

“These include having a parent with mental health problems or history of suicide, poor parental-child relationships, unsupportive parental and school beliefs when identifying as LGBTQ, social isolation resulting from not being in school or maintaining a job, housing insecurity, and living in a corrections facility or residential facility [8•, 23, 24, 25].”

• cites 8•Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites [23] Geulayov G, Gunnell D, Holmen TL, Metcalfe C. The association of parental fatal and non-fatal suicidal behaviour with offspring suicidal behaviour and depression: a systematic review and meta-analysis. Psychol Med. 2012;42(8):1567–80. sourceNot checked — no full text of the source
• cites [24] Rimes KA, Shivakumar S, Ussher G, Baker D, Rahman Q, West E. Psychosocial factors associated with suicide attempts, ideation, and future risk in lesbian, gay, and bisexual youth. crisis. 2019;40(2):83–92. https://doi.org/10.1027/0227-5910/a000527. sourcePartly supported

  The Discussion reports associations between suicidality and negative parental reactions to coming out, lower social support, lack of acceptance where one lives, and negative LGBTQ-related school experiences. It does not establish the claimed links to parental mental illness or suicide history, isolation specifically caused by not being in school or employed, housing insecurity, or residence in a corrections or residential facility. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

May combine two claims.

These adolescents may instead present with mood lability, irritability, low frustration tolerance, temper tantrums or agitation, somatic complaints, and/or social withdrawal.

“They may instead present with mood lability, irritability, low frustration tolerance, temper tantrums or agitation, somatic complaints, and/or social withdrawal instead of verbalizing feelings of depression [54].”

• cites [54] Birmaher B, Brent D. AACAP Work Group on Quality Issues Practice parameter for the assessment and treatment of children and adolescents with depressive disorders. J Am Acad Child Adolesc Psychiatry. 2007;46(11):1503–26. https://doi.org/10.1097/chi.0b013e318145ae1c. sourcePartly supported

  The Clinical Presentation passage lists mood lability, irritability, low frustration tolerance, temper tantrums, somatic complaints, and social withdrawal instead of verbalizing depression. It describes this presentation in children, not specifically adolescents, and does not include agitation in that list. No page number is supplied for the passage. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

May combine two claims.

Opioid misuse increases risk of suicide behaviors and attempts, placing trauma patients at additional risk.

“Further research as aforementioned has highlighted the increased risk of suicide behaviors and attempts with opioid misuse, placing traumatically increased trauma patients at additional risk.”

• cites [21] Wilkins NJ, Clayton H, Jones CM, Brown M. Current prescription opioid misuse and suicide risk behaviors among high school students. Pediatrics. 2021;1:e2020030601. https://doi.org/10.1542/peds.2020-030601. sourcePartly supported

  The Discussion says high school students reporting prescription opioid misuse were at elevated risk for suicide-related behaviors, including attempts. It also says the cross-sectional findings cannot establish causation. The paper does not study trauma patients, so it does not support extending that finding to them. (LLM, conf=0.88)

  Experimental — accuracy not yet measured
• cites [22] Baiden P, Graaf G, Zaami M, Acolatse CK, Adeku Y. Examining the association between prescription opioid misuse and suicidal behaviors among adolescent high school students in the United States. J Psychiatr Res. 2019;112:44–51. sourceNot checked — no full text of the source

May combine two claims.

Living in a home with a firearm increases risk of suicide by firearm, which has a fatality rate up to 85%.

“In addition, living in a home with a firearm increases the risk of suicide by firearm, which has a fatality rate of up to 85% [26].”

• cites [26] Fowler KA, Dahlberg LL, Haileyesus T, Annest JL. Firearm injuries in the United States. Prev Med. 2015;79:5–14. https://doi.org/10.1016/j.ypmed.2015.06.002. sourcePartly supported

  The Results section (‘The extent of firearm injuries and deaths in the U.S.’; page unavailable) reports an 85% case-fatality rate for firearm-related self-harm in 2010–2012. The Discussion also says about 85% of people who attempt suicide with a firearm die from the injury. Neither passage establishes that living in a home with a firearm increases the risk of firearm suicide. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

May combine two claims.

The CPSS can screen for PTSD in children and is validated in traumatized children over age 7.

“The Child PTSD Symptom Scale (CPSS) can be utilized to screen for PTSD in children and is validated in traumatized children over the age of 7 [68].”

• cites [68] Foa EB, Asnaani A, Zang Y, Capaldi S, Yeh R. Psychometrics of the Child PTSD Symptom scale for DSM-5 for trauma-exposed children and adolescents. J Clin Child Adolesc Psychol. 2018;47(1):38–46. sourceSupported

May combine two claims.

The PHQ-2 can be used as a rapid screen with remaining items given if positive, but the full PHQ-9 performs better in adolescents.

“There is a PHQ-2 that can serve as a “rapid screen” with the remaining questions administered if positive, although the full PHQ-9 performs better in the adolescent population [65].”

• cites [65] Allgaier AK, Pietsch K, Frühe B, SiglGlöckner J, Schulte-Körne G. Screening for depression in adolescents: validity of the patient health questionnaire in pediatric care. Depress Anxiety. 2012;29(10):906–913 47. sourcePartly supported

  The Discussion (page not provided) describes the PHQ-2 as a possible ultra-short screening compromise and says the PHQ-9 outperformed it in adolescents. The Measures section identifies the PHQ-2 as the first two PHQ-9 items, but the paper does not say to administer the remaining items after a positive PHQ-2 result; its Discussion instead calls for extensive clinical exploration after a positive screen. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

May combine two claims.

Less than 50% of all patients are screened for suicidality, 25% for depression, and 7% for PTSD symptoms at level I and II trauma centers across the USA.

“Less than 50% of all patients are screened for suicidality, 25% for depression, and 7% for PTSD symptoms at level I and II trauma centers across the USA [58].”

• cites [58] Love J, Zatzick D. A survey of screening & intervention for comorbid alcohol, drugs, suicidality, depression & PTSD at trauma centers. Psychiatr Serv. 2014;65:918–23. sourcePartly supported

  The Results report that 49% of trauma centers screened for suicide, 23% for depression, and 7% for PTSD. These are percentages of centers reporting screening practices, not percentages of all patients screened; the cited depression figure is also 23%, not 25%. (LLM, conf=0.90)

  Experimental — accuracy not yet measured

May combine two claims.

Firearms are lethal in 74-85% of suicide attempts and are tied for the second leading mechanism of adolescent suicide.

“Firearms are lethal 74–85% of the time when used for a suicide attempt and tied for the second leading mechanism of adolescent suicide [1, 26].”

• cites [1] Web-based Injury Statistics Query and Reporting System. Centers for Disease Control and Prevention. https://wisqars-viz.cdc.gov:8006/lcd/home. Accessed 15 Apr 2021.Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites [26] Fowler KA, Dahlberg LL, Haileyesus T, Annest JL. Firearm injuries in the United States. Prev Med. 2015;79:5–14. https://doi.org/10.1016/j.ypmed.2015.06.002. sourcePartly supported

  The Discussion reports that about 85% of people who use a firearm to attempt suicide die from their injury, supporting the upper end of the stated range. Our copy does not establish the 74% lower bound or rank firearms as tied for the second leading mechanism of adolescent suicide; its Introduction instead discusses firearm homicide among youth. (LLM, conf=0.87)

  Experimental — accuracy not yet measured

May combine two claims.

The PHQ-9 is a 9-item depression screen validated in adults and adolescents that includes a suicidal thoughts question.

“The Patient Health Questionnaire-9 (PHQ-9), a 9-item screening instrument for depression, is validated in adults and adolescents and has a question specifically inquiring about suicidal thoughts.”

• cites [65] Allgaier AK, Pietsch K, Frühe B, SiglGlöckner J, Schulte-Körne G. Screening for depression in adolescents: validity of the patient health questionnaire in pediatric care. Depress Anxiety. 2012;29(10):906–913 47. sourceSupported

May combine two claims.

Studies show relatively low adherence to screening recommendations in pediatric trauma centers, significant variation in who is screened by age, injury severity, and mechanism, and disparities in referrals for support services.

“Studies demonstrate relatively low adherence to screening recommendations in pediatric trauma centers, significant variation in who is screened based on age, injury severity, and mechanism of injury, and disparities in referrals for support services [72–74].”

• cites [72] Maung AA, Becher RD, Schuster KM, Davis KA. When should screening of pediatric trauma patients for adult behaviors start? J Trauma Surg Acute Open. 2018;3:e000181. sourcePartly supported

  The Background reports that pediatric trauma patients are screened less commonly than recommended, and the Results report alcohol testing in 45% and drug toxicology screening in 47% of the study cohort. The paper discusses age-related differences in high-risk behaviors and recommends screening adolescents regardless of injury severity, but it does not establish that screening itself varied by age, severity, or mechanism. Our copy also does not report disparities in referrals for support services. (LLM, conf=0.88)

  Experimental — accuracy not yet measured
• cites [73] Johnson KN, Raetz A, Harte M, McMahon LE, Grandsoult V, Garcia-Filion P, Notrica DM. Pediatric trauma patient alcohol screening: a 3 year review of screening at a level I pediatric trauma center using the CRAFFT tool. J Pediatr Surg. 2014;49(2):330–2. https://doi.org/10.1016/j.jpedsurg.2013.10.012. sourceNot checked — no full text of the source
• cites [74] Robinson T, Tarzi C, Zhou XG, Bailey K. Screening for alcohol and substance use in pediatric trauma patients: a retrospective review. J Pediatr Surg. 2020;55(5):921–5. https://doi.org/10.1016/j.jpedsurg.2020.01.042. sourceNot checked — no full text of the source

May combine two claims.

The ASQ is a 4-item suicide-specific tool that is easy to administer, validated in adults and adolescents, and highly sensitive in the pediatric emergency department.

“Suicide-specific instruments include the 4-item Ask Suicidal-Screening Questions (ASQ); it is easy to administer, validated among adults and adolescents, and has high sensitivity in the pediatric ED population [67].”

• cites [67] Horowitz LM, Bridge JA, Teach SJ, Ballard E, Klima J, Rosenstein DL, Wharff EA, Ginnis K, Cannon E, Joshi P, Pao M. Ask Suicide-Screening Questions (ASQ): a brief instrument for the pediatric emergency department. Arch Pediatr Adolesc Med. 2012;166(12):1170–6. sourcePartly supported

  The Results—Conclusions section describes the ASQ as a brief four-question tool for rapidly assessing suicide risk in pediatric EDs and reports high sensitivity. The Methods—Study Settings and Sample section limits participants to ages 10–21; the Results—Comment limitations also state that the ASQ was not administered to a validation cohort. Thus, this paper does not establish validation among adults generally. Page numbers are unavailable in our copy. (LLM, conf=0.90)

  Experimental — accuracy not yet measured

May combine two claims.

Step-up PTSD screening and mental health care models have the potential to improve support for pediatric and adult trauma patients, adapt to trauma centers with varying resources, and extend services via telehealth to address mental healthcare barriers.

“Step-up models of care for PTSD screening and mental health care have the potential to improve mental health support for pediatric and adult trauma patients, be adapted to meet the needs of trauma centers with varying resources, and extend services via telehealth to address barriers to mental healthcare [93, 94•, 95].”

• cites [93] Zatzick D, Jurkovich G, Rivara FP, Russo J, Wagner A, Wang J, Dunn C, Lord SP, Petrie M, Oʼconnor SS, Katon W. A randomized stepped care intervention trial targeting posttraumatic stress disorder for surgically hospitalized injury survivors. Ann Surg. 2013 257(3):390–9. https://doi.org/10.1097/SLA.0b013e31826bc313. sourcePartly supported

  The Methods (Participants; Stepped Collaborative Care Intervention; pages not supplied) describe a stepped PTSD intervention for adults aged 18 and older that was designed for delivery in person or by telephone. The Discussion says the model could inform trauma-center screening and care, but cautions that its screening and care management may be too resource-intensive for broad use. This paper does not establish its applicability to pediatric patients or to trauma centers with varying resources, and it does not assess whether telephone delivery overcomes barriers to mental healthcare. (LLM, conf=0.87)

  Experimental — accuracy not yet measured
• cites 94•Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites [95] deRoon-Cassini TA, Hunt JC, Geier TJ, Warren AM, Ruggiero KJ, Scott K, et al. Screening and treating hospitalized trauma survivors for posttraumatic stress disorder and depression. J Trauma Acute Care Surg. 2019;87(2):440–50. https://doi.org/10.1097/TA.0000000000002370. sourcePartly supported

  The Stepped Collaborative Care Models section describes potential mental-health benefits after traumatic injury; Program funding and creative solutions discusses adapting care to centers’ resources; and Telehealth care’s role in improving access to care describes addressing mobility and geographic barriers. The review specifies adult traumatic-injury populations in Screens for the hospitalized injured population, so it does not establish the claim’s extension to pediatric patients. Page numbers were not supplied in our copy. (LLM, conf=0.87)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing).

More guidance and recommendations exist for pain management strategies to increase non-opioid analgesia use and reduce outpatient prescription doses.

“There is more guidance and recommendations provided about pain management strategies to increase utilization of non-opioid analgesia and reduce doses of outpatient prescriptions [50, 91].”

• cites [50] Oquendo MA, Volkow ND. Suicide: a silent contributor to opioid-overdose deaths. N Engl J Med. 2018;26;378(17):1567–1569. https://doi.org/10.1056/NEJMp1801417. sourceNot checked — no full text of the source
• cites [91] Sudhanthar S, Thakur K, Sigal Y, Turner J. Improving validated depression screen among adolescent population in primary care practice using electronic health records (EHR). BMJ Qual Improv Rep. 2015;4(1):u209517.w3913. https://doi.org/10.1136/bmjquality.u209517.w3913. sourceCould not verify

  The Design and Strategy sections describe EHR-based depression screening for adolescents, not pain management. Searches for non-opioid analgesia, pain-management guidance, and outpatient prescribing found no passage addressing the attributed claim. (LLM, conf=0.78)

  Experimental — accuracy not yet measured

May combine two claims.

Co-occurring suicide and injury risk factors-mental illness, violence exposure, substance abuse-plus elevated risk after injury, especially TBI, SCI, and assault, make adolescent trauma patients very high risk for suicide.

“The co-occurring risk factors for suicide and injury including mental illness, exposures to violence, and substance abuse, in addition to the elevated risk after injury, especially in specific injuries such as TBI, SCI, and assault, all contribute to making the adolescent trauma patient population very high risk for suicide [8•, 38, 40, 41, 42, 43••].”

• cites 8•Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites [38] Madsen T, Erlangsen A, Orlovska S, Mofaddy R, Nordentoft M, Benros ME. Association between traumatic brain injury and risk of suicide. JAMA. 2018;320(6):580–8. https://doi.org/10.1001/jama.2018.10211. sourcePartly supported

  The Abstract reports a higher suicide rate after TBI, and the Results include analyses by age at first TBI, including adolescent ages. The paper does not establish that adolescent trauma patients as a group are at very high risk, or address the claimed risks after spinal cord injury or assault and the full set of co-occurring factors. No page numbers are supplied for these passages in our copy. (LLM, conf=0.88)

  Experimental — accuracy not yet measured
• cites 43••Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

The step-up model provides universal PTSD screening but focuses intervention time and resources on those who screen positive.

“A promising model of assessing and providing treatment PTSD for patients after traumatic injury is the step-up model of care that provides universal screening for PTSD, but focuses time and resources for intervention on only those that screen positive.”

• cites [93] Zatzick D, Jurkovich G, Rivara FP, Russo J, Wagner A, Wang J, Dunn C, Lord SP, Petrie M, Oʼconnor SS, Katon W. A randomized stepped care intervention trial targeting posttraumatic stress disorder for surgically hospitalized injury survivors. Ann Surg. 2013 257(3):390–9. https://doi.org/10.1097/SLA.0b013e31826bc313. sourcePartly supported

  The Methods (Design and Setting; Assessments: PTSD Symptoms, page not available) describe screening eligible, consenting surgical inpatients and enrolling only those who screened positive twice for the intervention trial. This supports directing intervention to patients with positive screens, but not universal screening of all patients after traumatic injury. The Discussion (page not available) also cautions that the trial’s screening and care-management procedures may be too resource-intensive for broad use. (LLM, conf=0.85)

  Experimental — accuracy not yet measured
• cites 94•Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

The step-up model has demonstrated improved PTSD outcomes and quality of life.

“This model has demonstrated improved outcomes related to PTSD and improved quality of life”

• cites [93] Zatzick D, Jurkovich G, Rivara FP, Russo J, Wagner A, Wang J, Dunn C, Lord SP, Petrie M, Oʼconnor SS, Katon W. A randomized stepped care intervention trial targeting posttraumatic stress disorder for surgically hospitalized injury survivors. Ann Surg. 2013 257(3):390–9. https://doi.org/10.1097/SLA.0b013e31826bc313. sourcePartly supported

  The Results (Symptomatic and Functional Outcomes; page not provided) report reduced PTSD symptoms and improved physical function in intervention patients. The Methods identify the functional measure as the SF-36 Physical Component Summary, but the copy does not report an improvement in overall quality of life. (LLM, conf=0.85)

  Experimental — accuracy not yet measured
• cites 94•Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

Higher minimum ages for firearm ownership and concealed carry (>21), permit-to-purchase laws, waiting periods, and child access prevention laws are associated with lower adolescent suicide rates.

“Higher minimum ages for firearm ownership and concealed carry (> 21), permit-to-purchase laws, minimum waiting periods for purchase, and child access prevention laws are associated with lower rates of adolescent suicide [97–99].”

• cites [97] Bhatt A, Wang X, Cheng AL, Morris KL, Beyer L, Chestnut A, et al. Association of changes in Missouri firearm laws with adolescent and young adult suicides by firearms. JAMA Netw Open. 2020;3(11):e2024303. https://doi.org/10.1001/jamanetworkopen.2020.24303. sourcePartly supported

  The Discussion and Conclusions (page numbers unavailable) link Missouri’s repeal of its permit-to-purchase law to higher firearm-suicide rates in young adults and changes to its concealed-carry law to higher rates among young residents. The paper does not establish an association for minimum firearm-ownership ages above 21, waiting periods, or child access prevention laws; its permit-to-purchase finding concerns young adults rather than adolescents specifically. (LLM, conf=0.88)

  Experimental — accuracy not yet measured
• cites [98] Kalesan B, Mobily ME, Keiser O, Fagan JA, Galea S. Firearm legislation and firearm mortality in the USA: a cross-sectional, state-level study. Lancet. 2016;387:1847–55. sourceNot checked — no full text of the source
• cites [99] Raifman J, Larson E, Barry CL, Siegel M, Ulrich M, Knopov A, Galea S. State handgun purchase age minimums in the US and adolescent suicide rates: regression discontinuity and difference-in-differences analyses. BMJ. 2020;22(370):m2436. https://doi.org/10.1136/bmj.m2436. sourcePartly supported

  The Discussion and Conclusion report lower suicide rates among adolescents aged 18–20 associated with a minimum handgun purchase age of 21, and the Discussion reports prior research associating child access prevention laws with lower suicide rates among adolescents younger than 17. The paper does not establish the claimed associations for concealed-carry age minimums, permit-to-purchase laws, or waiting periods. It studies handgun purchase at age 21 or older, not firearm ownership or a minimum age greater than 21. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

May combine two claims.

In the TRRP evaluation including teen and adult patients, 98% accepted PTSD screening enrollment, 36% screened positive, and 75% either accepted referrals or were already receiving care.

“Evaluation of the program that included teen and adult patients demonstrated 98% of patients accepted enrollment for PTSD screening and of the 36% that screened positive, and 75% either accepted referrals or were already receiving care [94•].”

• cites 94•Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

Over the past 20 years, suicide incidence increased for all races, with the largest increases among American Indian youth.

“Over the past 20 years, the incidence of suicide has increased for all races, with the most drastic increases in American Indian youth.”

• cites [1] Web-based Injury Statistics Query and Reporting System. Centers for Disease Control and Prevention. https://wisqars-viz.cdc.gov:8006/lcd/home. Accessed 15 Apr 2021.Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Alaska, South Dakota, Wyoming, and Montana have the highest suicide rates for youths aged 10-19, while DC, New Jersey, New York, and Massachusetts have the lowest.

“Alaska, South Dakota, Wyoming, and Montana have the highest rates of suicides for youths aged 10–19, while the District of Columbia, New Jersey, New York, and Massachusetts report the lowest rates of suicides [1].”

• cites [1] Web-based Injury Statistics Query and Reporting System. Centers for Disease Control and Prevention. https://wisqars-viz.cdc.gov:8006/lcd/home. Accessed 15 Apr 2021.Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

Firearm and suffocation suicide deaths have been relatively stable recently, though firearms outnumbered other mechanisms 20 years ago; firearms accounted for 49% in 2001 versus 38% for suffocation/asphyxiation.

“Deaths from firearms and suffocation have been relatively stable in the past few years, although firearm deaths outnumbered other mechanisms 20 years ago; firearms accounted for 49% suicide deaths in 2001 compared to 38% which were due to suffocation/asphyxiation [1].”

• cites [1] Web-based Injury Statistics Query and Reporting System. Centers for Disease Control and Prevention. https://wisqars-viz.cdc.gov:8006/lcd/home. Accessed 15 Apr 2021.Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

Additional suicide mechanisms include drug poisoning (6%) and falls (3%), with cut/pierce, burns, drowning, and non-drug poisoning each less than 1%.

“Additional mechanisms include drug poisoning (6%) and falls (3%), and less than 1% each include cut/pierce, burns, drowning, and non-drug poisoning.”

• cites [1] Web-based Injury Statistics Query and Reporting System. Centers for Disease Control and Prevention. https://wisqars-viz.cdc.gov:8006/lcd/home. Accessed 15 Apr 2021.Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

Male adolescents have higher suicide fatality, likely due to use of more lethal means such as firearms.

“It is well established in the literature that females have significantly more suicide attempts than males, but males have higher fatalities, likely due to use of more lethal means in the form of firearms [5, 8•].”

• cites [5] Mathews EM, Woodward CJ, Musso MW, Jones GN. Suicide attempts presenting to trauma centers: trends across age groups using the National Trauma Data Bank. Am J Emerg Med. 2016;34(8):1620–4. https://doi.org/10.1016/j.ajem.2016.06.014. sourceNot checked — no full text of the source
• cites 8•Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

History of adoption, physical abuse and neglect, IPV, bullying experience/perpetration, and pathologic Internet use are risk factors for suicide.

“History of adoption, physical abuse and neglect, intimate partner violence (IPV), experience and perpetration of bullying, and pathologic Internet use are noted risk factors [8•, 16 ,17, 18, 19].”

• cites 8•Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites [16] Slap G, Goodman E, Huang B. Adoption as a risk factor for attempted suicide during adolescence. Pediatrics. 2001;108(2):E30. https://doi.org/10.1542/peds.108.2.e30. sourceNot checked — no full text of the source
• cites [17] Messias E, Castro J, Saini A, Usman M, Peeples D. Sadness, suicide, and their association with video game and internet overuse among teens: results from the youth risk behavior survey 2007 and 2009. Suicide Life Threat Behav. 2011;41(3):307–15. https://doi.org/10.1111/j.1943-278X.2011.00030.x. sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

Step-up models of care for PTSD are promising for increasing screening and services after injury.

“Step-up models of care for PTSD are promising to increase screening and services after injury.”

May combine two claims.

The leading suicide mechanisms are suffocation (43%) and firearm injury (43%).

“The leading mechanisms of suicide are suffocation (43%) and firearm injury (43%) (Fig. 2).”

• cites [1] Web-based Injury Statistics Query and Reporting System. Centers for Disease Control and Prevention. https://wisqars-viz.cdc.gov:8006/lcd/home. Accessed 15 Apr 2021.Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

American Indian youth have the highest suicide incidence, followed by non-Hispanic whites, reaching up to 24 per 100,000.

“American Indians have the highest incidence followed by non-Hispanic whites, reaching as high as 24 per 100,000 youths (Fig. 1).”

• cites [1] Web-based Injury Statistics Query and Reporting System. Centers for Disease Control and Prevention. https://wisqars-viz.cdc.gov:8006/lcd/home. Accessed 15 Apr 2021.Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S4 (based).

Short screening instruments exist that can be used to universally screen adolescent trauma patients for depression and suicidality.

“There are short screening instruments that can be used to universally screen for depression and suicidality in adolescent trauma patients.”

May combine two claims.

Adolescent suicide incidence in the USA rose to 6.5 per 100,000 by 2019, with racial disparities.

“The incidence of adolescent suicide has continued to rise in the USA to 6.5 per 100,000, with notable racial disparities.”

• Also stated in: § Epidemiology · plain

  “The incidence of adolescent suicide has increased from 4.57 per 100,000 in 2001 to 6.5 per 100,000 in 2019, and there are notable differences and trends among age, race, sex, and geographic region [1].”

• cites [1] Web-based Injury Statistics Query and Reporting System. Centers for Disease Control and Prevention. https://wisqars-viz.cdc.gov:8006/lcd/home. Accessed 15 Apr 2021.Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

Male sex, American Indian, and Hispanic adolescents experience higher suicide rates.

“As noted previously, there are fixed demographic groups including male sex, American Indians, and Hispanics who experience higher rates of suicide [1].”

• cites [1] Web-based Injury Statistics Query and Reporting System. Centers for Disease Control and Prevention. https://wisqars-viz.cdc.gov:8006/lcd/home. Accessed 15 Apr 2021.Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing).

In 2019, 2744 US adolescents aged 10-19 died by suicide.

“Suicide is the second leading cause of death for adolescents between the ages 10 and 19 in the USA, accounting for 2744 deaths in 2019 [1].”

• cites [1] Web-based Injury Statistics Query and Reporting System. Centers for Disease Control and Prevention. https://wisqars-viz.cdc.gov:8006/lcd/home. Accessed 15 Apr 2021.Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

Prior suicidal ideation, severity of ideation, and prior suicide attempts are among the highest predictors of future suicide attempts.

“Prior suicidal ideation, severity of ideation, and prior suicide attempts are among the highest predictors of future suicide attempts [7••].”

• cites 7••Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing).

Female adolescent suicide rates doubled from 1.64 per 100,000 in 2001 to 3.48 per 100,000 in 2019.

“When comparing the rate of adolescent suicide between sexes, males have a significantly higher rate of deaths; however, female suicide rates have doubled since 2001, from 1.64 per 100,000 in 2001 to 3.48 per 100,000 in 2019.”

• cites [1] Web-based Injury Statistics Query and Reporting System. Centers for Disease Control and Prevention. https://wisqars-viz.cdc.gov:8006/lcd/home. Accessed 15 Apr 2021.Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

Many adolescents with self-inflicted injuries or suicidal behaviors are treated in the ED and may not be seen by the trauma team.

“In addition, many adolescents that present with self-inflicted injuries or suicidal behaviors are often treated in the emergency department (ED) and may not be encountered by the trauma team [4].”

• cites [4] Sawyer SM, Patton GC. Why are so many more adolescents presenting to our emergency departments with mental health problems? Med J Aust. 2018;208(8):339–40. https://doi.org/10.5694/mja18.00213. sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

High rates of alcohol abuse among trauma patients may contribute to the increased suicide completion risk after traumatic injury.

“One of the first studies assessing suicide after traumatic injury included patients 15 and over and showed an increased risk of suicide completion after traumatic injury compared to the general population predominately among young adults, noting though that the high rates of alcohol abuse among trauma patients may attribute to this difference [41].”

• cites [41] Ryb GE, Soderstrom CA, Kufera JA, Dischinger P. Longitudinal study of suicide after traumatic injury. J Trauma. 2006;61(4):799–804. https://doi.org/10.1097/01.ta.0000196763.14289.4e. sourceNot checked — no full text of the source

May combine two claims.

Warning signs associated with suicide include changes in eating or sleeping habits, frequent sadness, withdrawal from family/friends/activities, frequent physical complaints related to emotions, decline in academic performance, and preoccupation with death and dying.

“These warning signs include changes in eating or sleeping habits, frequent sadness, withdrawal from family, friends and regular activities, frequent physical complaints related to emotions (headaches, fatigue, stomach aches), decline in academic performance, and preoccupation with death and dying [55].”

• cites [55] AACAP. Frequently Asked Questions. Retrieved April 24, 2021, from Aacap.org website: https://www.aacap.org/AACAP/Families_and_Youth/Resource_Centers/Suicide_Resource_Center/FAQ.aspx. Accessed 20 Apr 2021.Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Up to 11% of deaths after spinal cord injury are attributed to suicide, mostly from firearms.

“Spinal cord injury (SCI) is also associated with higher rates of suicidal ideation and death by suicide, with up to 11% of deaths after SCI being attributed to suicide, mostly from firearms [40].”

• cites [40] Kennedy P, Garmon-Jones L. Self-harm and suicide before and after spinal cord injury: a systematic review. Spinal Cord. 2017;55(1):2–7. https://doi.org/10.1038/sc.2016.135. sourceNot checked — no full text of the source

May combine two claims.

One of the first studies assessing suicide after traumatic injury included patients 15 and over and showed increased risk of suicide completion after traumatic injury compared to the general population, predominantly among young adults.

“One of the first studies assessing suicide after traumatic injury included patients 15 and over and showed an increased risk of suicide completion after traumatic injury compared to the general population predominately among young adults, noting though that the high rates of alcohol abuse among trauma patients may attribute to this difference [41].”

• cites [41] Ryb GE, Soderstrom CA, Kufera JA, Dischinger P. Longitudinal study of suicide after traumatic injury. J Trauma. 2006;61(4):799–804. https://doi.org/10.1097/01.ta.0000196763.14289.4e. sourceNot checked — no full text of the source

May combine two claims.

In that study, suicidal ideation risk fluctuated, and notable risks included pre-existing depression, history of suicidality, recent stressful events, current pain, mild TBI, and current diagnoses of depression, PTSD, anxiety disorder, or substance use disorder.

“This risk was found to fluctuate, and notable risks included pre-existing depression, history of suicidality, recent stressful events, current level of pain, mild TBI, and current diagnoses of depression, PTSD, anxiety disorder, or substance use disorder [42].”

• cites [42] Bryant RA, O’Donnell ML, Forbes D, McFarlane AC, Silove D, Creamer M. The course of suicide risk following traumatic injury. J Clin Psychiatry. 2016;77(5):648–53. https://doi.org/10.4088/JCP.14m09661. sourceNot checked — no full text of the source

May combine two claims.

If avoidance and emotional numbing are present, the adolescent may appear unaffected by trauma, and re-experiencing symptoms may be masked.

“If avoidance and affective or emotional numbing are present, the adolescent may appear to be unaffected by the trauma, and re-experiencing symptoms may be masked [56].”

• cites [56] Cohen JA, Bukstein O, Walter H, Benson SR, Chrisman A, Farchione TR, et al. AACAP Work Group On Quality Issues Practice parameter for the assessment and treatment of children and adolescents with posttraumatic stress disorder. J Am Acad Child Adolesc Psychiatry. 2010;49(4):414–30. sourceNot checked — no full text of the source

Classified as probably not a substantial claim. May combine two claims.

PTSD symptoms include persistent exaggerated negative beliefs about oneself, blaming oneself for the traumatic event, persistent negative emotional state, loss of interest in activities, and persistent inability to experience positive emotions.

“These include persistent exaggerated negative beliefs about oneself, blaming oneself for the traumatic event, persistent negative emotional state, loss of interest in activities, and persistent inability to experience positive emotions such as happiness, satisfaction, or loving feelings.”

• cites [56] Cohen JA, Bukstein O, Walter H, Benson SR, Chrisman A, Farchione TR, et al. AACAP Work Group On Quality Issues Practice parameter for the assessment and treatment of children and adolescents with posttraumatic stress disorder. J Am Acad Child Adolesc Psychiatry. 2010;49(4):414–30. sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

The CES-DC was created specifically for children.

“The Center for Epidemiological Studies Depression Scale for Children (CES-DC) was developed specifically for children [66].”

• cites [66] Center for Epidemiological Studies Depression Scale for Children (CES-DC): instructions for use. https://www.brightfutures.org/mentalhealth/pdf/professionals/bridges/ces_dc.pdf. Accessed 20 Apr 2021.Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing).

The US Preventive Services Task Force advises depression screening for adolescents when adequate systems for screening, treatment, and referrals exist.

“the United States Preventative Task Force (USPTF) recommend screening adolescent patients for depression when adequate systems exist for screening, treatment, and referrals”

• cites [59] USPTF Final Recommendation Statement: Depression in Children and Adolescents. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/depression-in-children-and-adolescents-screening. Published Feb 8 2016. Accessed 12 Apr 2021.Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites [60] Zuckerbrot RA, Cheung A, Jensen PS, Stein REK, Laraque D; GLAD-PC STEERING GROUP. Guidelines for Adolescent Depression in Primary Care (GLAD-PC): Part I. Practice preparation, identification, assessment, and initial management. Pediatrics. 2018;141(3):e20174081. https://doi.org/10.1542/peds.2017-4081. sourceNot checked — no full text of the source

Classified as probably not a substantial claim.

The AAP advises yearly screening for patients aged 12 and older.

“The American Academy of Pediatrics (AAP) recommends screening patients age 12 and over annually”

• cites [59] USPTF Final Recommendation Statement: Depression in Children and Adolescents. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/depression-in-children-and-adolescents-screening. Published Feb 8 2016. Accessed 12 Apr 2021.Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites [60] Zuckerbrot RA, Cheung A, Jensen PS, Stein REK, Laraque D; GLAD-PC STEERING GROUP. Guidelines for Adolescent Depression in Primary Care (GLAD-PC): Part I. Practice preparation, identification, assessment, and initial management. Pediatrics. 2018;141(3):e20174081. https://doi.org/10.1542/peds.2017-4081. sourceNot checked — no full text of the source

May combine two claims.

Over 13 million US children live in homes with firearms, and about 4.6 million of those live in homes where guns are loaded and unlocked.

“Over 13 million children in the USA live in homes with firearms and about 4.6 million of those reside in homes where guns are improperly stored (i.e., loaded and unlocked) [70].”

• cites [70] Kelleher DC, Renaud EJ, Ehrlich PF, Burd RS. Pediatric Trauma Society Guidelines Committee. Guidelines for alcohol screening in adolescent trauma patients: a report from the Pediatric Trauma Society Guidelines Committee. J Trauma Acute Care Surg. 2013 74(2):671–82. https://doi.org/10.1097/TA.0b013e31827d5f80. sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

The ACS Committee on Trauma endorses regular screening and referral for depression and PTSD in older adolescents and adults over 15.

“The American College of Surgeons Committee on Trauma (ACS COT) supports regular screening and referral for depression and PTSD in the older adolescent and adult population (over the age of 15)”

• cites [62] American College of Surgeons Committee on Trauma Statement on Post-Traumatic Stress Disorder in Adults. Published online Feb 1, 2018. https://www.facs.org/about-acs/statements/109-adult-ptsd. Accessed 12 Apr 2021.Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

Adolescents at risk of suicide are just as likely as those without such risks to report home firearm access, with 1 in 3 reporting access.

“Adolescents identified as at risk of suicide (mental illness, suicidality) are just as likely to report living in a home with firearm access as adolescents without such risks with 1 in 3 reporting access”

• cites [78] Grossman DC, Reay DT, Baker SA. Self-inflicted and unintentional firearm injuries among children and adolescents: the source of the firearm. Arch Pediatr Adolesc Med. 1999;153(8):875–8. sourceNot checked — no full text of the source
• cites [79] Simonetti JA, Mackelprang JL, Rowhani-Rahbar A, Zatzick D, Rivara FP. Psychiatric comorbidity, suicidality, and in-home firearm access among a nationally representative sample of adolescents. JAMA Psychiat. 2015;72(2):152–9. https://doi.org/10.1001/jamapsychiatry.2014.1760. sourceNot checked — no full text of the source

Classified as probably not a substantial claim.

The AAP recommends routine screening and counseling for firearm safety storage.

“The AAP recommends routine screening and counseling”

• cites [81] Dowd MD, Sege RD. Council on Injury, Violence, and Poison Prevention Executive Committee; American Academy of Pediatrics. Firearm-related injuries affecting the pediatric population. Pediatrics. 2012;130(5):e1416-23. https://doi.org/10.1542/peds.2012-2481. sourceNot checked — no full text of the source
• cites 82••Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

Opioids increase the risk of misuse, overdose, and suicide.

“opioids increase the risk of misuse, overdose, and suicide [50].”

• cites [50] Oquendo MA, Volkow ND. Suicide: a silent contributor to opioid-overdose deaths. N Engl J Med. 2018;26;378(17):1567–1569. https://doi.org/10.1056/NEJMp1801417. sourceNot checked — no full text of the source

May combine two claims.

Most healthcare providers agree they should provide firearm counseling but report barriers such as lack of time, inadequate training, and low self-efficacy.

“The majority of healthcare providers agree that they should provide firearm counseling but report many barriers to doing so including lack of time, inadequate training, and low self-efficacy [86].”

• cites [86] Webster DW, Wilson ME, Duggan AK, Pakula LC. Firearm injury prevention counseling: a study of pediatricians’ beliefs and practices. Pediatrics. 1992;89(5 Pt 1):902–7. sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

High acceptance of telehealth services may improve access to care, especially in rural communities with fewer mental health providers.

“The high acceptance of telehealth services may improve access to care, especially to those in rural communities with fewer mental health providers.”

May combine two claims.

Many opioid overdose deaths are misclassified as unintentional, so the suicide burden is likely underappreciated.

“There is also a valid concern that many opioid overdose deaths are misclassified as unintentional overdose; therefore, the burden of suicide is likely underappreciated [90].”

• cites [90] Yaster M, McNaull PP, Davis PJ. The opioid epidemic in pediatrics: a 2020 update. Curr Opin Anaesthesiol. 2020;33(3):327–34. https://doi.org/10.1097/ACO.0000000000000865. sourceNot checked — no full text of the source