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Cited by 78Suicide and Self-Harm StudiesAdolescent and Pediatric HealthcareHomicide, Infanticide, and Child Abuse

Screening pediatric medical patients for suicide risk: Is depression screening enough?

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Horowitz, Lisa M., Mournet, Annabelle M., Lanzillo, Elizabeth, He, Jian-Ping, Powell, Daniel S., Ross, Abigail M., Wharff, Elizabeth A., Bridge, Jeffrey A. +1 more·2021·Journal of Adolescent Health
DOI 10.1016/j.jadohealth.2021.01.028PMC PMC8154669
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Abstract

Purpose Medically ill youth are at increased risk for suicide. For convenience, hospitals may screen for suicide risk using depression screening instruments, though this practice might not be adequate to detect those at risk for suicide. This study aims to determine whether depression screening can detect suicide risk in pediatric medical inpatients who screen positive on suicide-specific measures.Methods A convenience sample of medical inpatients ages 10-21 years were recruited as part of a larger instrument validation study. Participants completed the Ask Suicide-Screening Questions, the Suicidal Ideation Questionnaire/Suicidal Ideation Questionnaire-Junior, and the Patient Health Questionnaire-Adolescent Version (PHQ-A). Univariate and multivariate statistics were calculated to examine the relationship between screening positive for depression and suicide risk.Results The sample consisted of 600 medical inpatients (59.2% female; 55.2% white; mean age 15.2 ± 2.84 years). Of participants who screened positive for suicide risk (13.5%; 81/600), 39.5% (32/81) did not screen positive for depression, and more than half (45/81) did not endorse PHQ-A item 9, which queries for thoughts of harming oneself or being better off dead. Twenty-six participants (32%) who screened negative for depression and on PHQ-A item nine were at risk for suicide.Conclusions In this sample, depression screening alone failed to detect nearly a third of youth at risk for suicide. Although depression and suicide risk are strongly related, a significant portion of pediatric medical inpatients at risk for suicide may pass through the healthcare system unrecognized if depression screening is used as a proxy for identifying suicide risk.

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  • General mental health or depression screens often under-detect young people experiencing suicidal ideation.

    “Using a specific suicide risk screening instrument is recommended, as general mental health or depression screens often under-detect young people experiencing suicidal ideation.”

    From Suicide in young people: screening, risk assessment, and intervention (2023) · cites this paper as [69]

    The Discussion reports that depression screening missed 32% of pediatric medical inpatients identified as at risk for suicide and recommends validated tools that ask youth directly about suicide. The study does not establish that general mental health screens under-detect suicidal ideation, and its finding is specific to pediatric medical patients and suicide risk rather than young people generally. (LLM, conf=0.84)

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  • Bisexual youth have significantly more suicide risk factors and fewer protective factors, along with elevated rates of suicidal ideation and attempts, compared with heterosexual and other sexual minority youth.

    “An additional study showed bisexual youth were associated with significantly more suicide risk factors (depression, trauma, victimization) and less protective factors (parent-family connectedness, positive affect), along with elevated rates of both ideation and attempts compared to heterosexual and other sexual minority youth.16”

    From Evidence-based youth suicide prevention and intervention in pediatric primary care settings. (2024) · cites this paper as [16]

  • Screening for both depression and suicide risk can significantly detect more individuals with elevated risk for suicidal behavior.

    “Evidence suggests screening for both depression and suicide risk can significantly detect more individuals with elevated risk for engaging in suicidal behavior.16”

    From Evidence-based youth suicide prevention and intervention in pediatric primary care settings. (2024) · cites this paper as [16]

  • Depression screening alone is not adequate to detect suicide risk, and not all youth at risk for suicide have depression symptoms.

    “research shows screening for depression alone is not adequate to detect suicide risk, and that not all youth at risk for suicide have depression symptoms.16,38”

    From Evidence-based youth suicide prevention and intervention in pediatric primary care settings. (2024) · cites this paper as [16]

  • In a study of medical inpatients aged 10-21, 39.5% who screened positive for suicide risk did not screen positive for depression on the PHQ-A, and 56% did not report thoughts of self-harm or being better off dead on PHQ-A item 9.

    “In a study among medical inpatients aged 10-21 years, 39.5% of participants who screened positive for suicide risk did not screen positive for depression using the Patient Health Questionnaire-Adolescent Version (PHQ-A), and 56% did not report thoughts of self-harm or “being better off dead” on item 9 of the PHQ-A.16”

    From Evidence-based youth suicide prevention and intervention in pediatric primary care settings. (2024) · cites this paper as [16]

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Authors
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.
Affiliations
  • National Institute of Mental Health (US)
  • Boston Children's Hospital (US)
  • Nationwide Children's Hospital (US)
Corresponding author
Horowitz, Lisa M.
ORCID
Venue
Journal of Adolescent Health
Publisher
Elsevier BV
Published
2021-06
Volume
68
Issue
6
Pages
1183-1188
ISSN
1054-139X (ISSN-L)
DOI
10.1016/j.jadohealth.2021.01.028
PMC
PMC8154669
OpenAlex
W3134780906
Cited by
78
References
37
Citations by year
2026: 8 · 2025: 17 · 2024: 15 · 2023: 17 · 2022: 16 · 2021: 5
FWCI
9.03
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Adolescent Health (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute of Mental Health
Topics
  • Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
  • Health Sciences › Health Professions › Speech and Hearing › Adolescent and Pediatric Healthcare
  • Social Sciences › Sociology and Political Science › Homicide, Infanticide, and Child Abuse
Keywords
suicide risk screening, depression screening, suicidal ideation, PHQ-A, adolescents, suicide risk identification
MeSH terms
Adolescent, Adult, Child, Depression, Female, Humans, Inpatients, Male, Mass Screening, Surveys and Questionnaires, Suicide, Young Adult, Suicidal Ideation

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