CoChat
Sign Up
Cited by 10Suicide and Self-Harm StudiesInjury Epidemiology and PreventionGun Ownership and Violence Research

Evidence-based youth suicide prevention and intervention in pediatric primary care settings.

Open access
Ruch, Donna A., Hughes, Jennifer L., Bridge, Jeffrey A., Fontanella, Cynthia A.·2024·Pediatric Clinics of North America
DOI 10.1016/j.pcl.2024.07.017PMC PMC11494147
Open this paper in CoChat — free account

Abstract

Suicide is a leading cause of death in youth. Evidence highlights the importance of identifying youth at risk for suicide in pediatric primary care, and suggests this is a crucial setting for improving youth mental health. The American Academy of Pediatrics recommends primary care providers not only screen and assess for suicide risk, but also become educated on how to better manage certain mental health conditions. This article discusses the epidemiology of youth suicide in the U.S. and describes evidence-based strategies and innovative practices for suicide prevention in pediatric primary care including suicide risk screening, assessment, intervention, and follow-up care.

AI snapshot

Written from the paper’s full text.

TL;DR

This review summarizes the epidemiology of U.S. youth suicide and evidence-based strategies for prevention in pediatric primary care, including screening, assessment, brief interventions, follow-up, and clinical pathways. It emphasizes universal suicide risk screening, safety planning, lethal means counseling, and follow-up care, while noting gaps in pediatric primary care evidence and provider training.

Key findings

  • Suicide is a leading cause of death among U.S. youth aged 10–19 and accounted for 23% of deaths in this age group in 2022; rates rose 27% from 2011 to 2022 (4.9 to 6.3 per 100,000). In the 2021 Youth Risk Behavior Survey, 22% of high school students seriously considered suicide and 10% attempted suicide in the prior 12 months.
  • Disparities are marked: American Indian/Alaska Native youth aged 10–19 had a 2018–2022 suicide rate of 25.8 per 100,000—3 times White youth (7.8 per 100,000) and over 4 times Black, Asian/Pacific Islander, and Hispanic youth. Males had 3 times higher rates than females in 2001–2021 and represented 77% of deaths, while females aged 10–14 showed the sharpest increase (0.8 to 1.9 per 100,000).
  • Depression screening alone misses youth at suicide risk: among 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 item 9; suicide-specific screening identified an additional 8.3% of patients aged 12–20 compared with depression screening alone.
  • Brief interventions and follow-up show benefit: a meta-analysis found safety-planning-type interventions reduced suicidal behavior by 43% (NNT=16); SPI with follow-up was associated with 3.03% vs 5.29% suicidal behavior over 6 months versus usual care; FISP increased outpatient treatment attendance (92.1% vs 76.2%, p=0.004) but had no significant effects on suicidality. Lethal means counseling made parents 4 times more likely to restrict access, yet only 19.4% of pediatric primary care providers reported consistently screening for firearms or providing such counseling.

Methods

  • Design: review article; no primary data collection.
  • Data/sample: synthesizes U.S. epidemiology, screening and assessment tools (ASQ, BSSA, C-SSRS, SAFE-T), brief interventions (SPI, FISP), follow-up care, clinical pathways, provider training, and collaborative care models.
  • Analysis: narrative synthesis of cited literature; no systematic search strategy, quality appraisal, or meta-analysis is described.

Limitations

  • Paper-stated: no psychometric validation studies of the BSSA at this time; no studies have evaluated collaborative care models’ effectiveness on suicidal behaviors in pediatric populations; future studies are needed to test the clinical pathway’s effectiveness in primary care.
  • Paper-stated: there is a paucity of randomized clinical trials on follow-up interventions for suicidal patients, and brief youth suicide prevention interventions have been most robustly tested in emergency department settings.
  • Evident from the text: as a narrative review, it does not report a systematic search or formal quality assessment, and several cited intervention findings come from adult samples, emergency department samples, or non-primary-care settings.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1016/j.pcl.2024.07.017

Cites

104 of 104 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 148 cited sources checked · 0 supported · 0 flagged

  • Premisecitation

    American Indian/Alaska Native youth experience the highest suicide rates in the US.

    “American Indian/Alaska Native (AI/AN) youth experience the highest rates of suicide in the U.S2”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [2] Centers for Disease Control and Prevention. Web-based Injury Statistics Query and Reporting System (WISQARS) Fatal Death Reports [online]. National Center for Injury Prevention and Control. Available at: https://webappa.cdc.gov/sasweb/ncipc/mortrate.html. (Accessed April 12 2024).

      Not checked in the free run.

  • Premisecitation

    Previous suicide attempts are the most robust clinical predictor of a future suicide attempt.

    “which includes previous suicide attempts, the most robust clinical predictor of a future suicide attempt.14,19”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [14] Bridge, 2018, Age-related racial disparity in suicide rates among US youths from 2001 through 2015, JAMA Pediatr source

      Not checked in the free run.

    • cites [19] Czyz, 2015, Longitudinal trajectories of suicidal ideation and subsequent suicide attempts among adolescent inpatients, J Clin Child Adolesc Psychol source

      Not checked in the free run.

  • Premisecitation

    Research consistently shows a significant association between youth suicide and mental health issues, including previous suicide attempts.

    “Research consistently shows a significant association between youth suicide and mental health issues,17,18 which includes previous suicide attempts, the most robust clinical predictor of a future suicide attempt.14,19”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [17] Perou, 2013, Mental health surveillance among children--United States, 2005-2011, MMWR Suppl

      Not checked in the free run.

    • cites [18] Ghandour, 2019, Prevalence and treatment of depression, anxiety, and conduct problems in US children, J Pediatr source

      Not checked in the free run.

  • Premisecitation

    Comorbidity of mental health issues and substance abuse disorders significantly increases risk for youth suicide and suicidal behavior.

    “Comorbidity of mental health issues and substance abuse disorders are also shown to significantly increase the risk for youth suicide and suicidal behavior.21”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [21] Goldston, 2009, Psychiatric diagnoses as contemporaneous risk factors for suicide attempts among adolescents and young adults: Developmental changes, J Consult Clin Psychol source

      Not checked in the free run.

  • Premisecitation

    Economic, geographic, or cultural barriers may limit access to mental health services in rural and underserved communities.

    “This is particularly concerning for rural and underserved communities where economic, geographic, or cultural barriers may limit access to mental health services.9,10”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [9] Andrilla, 2018, Geographic variation in the supply of selected behavioral health providers, Am J Prev Med source

      Not checked in the free run.

    • cites [10] Cummings, 2017, Geographic access to specialty mental health care across high- and low-income US communities, JAMA Psychiatr source

      Not checked in the free run.

  • Classified as probably not a substantial claim. 34
  • May combine two claims. 44

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

    Premisecitation

    Between 2001 and 2021, male youth suicide rates were three times higher than female rates and represented 77% of suicide deaths among 10- to 19-year-olds.

    “Between 2001-2021, youth suicide rates in males were 3 times higher than females and represented 77% of all suicide deaths in 10- to 19-year-olds2”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [2] Centers for Disease Control and Prevention. Web-based Injury Statistics Query and Reporting System (WISQARS) Fatal Death Reports [online]. National Center for Injury Prevention and Control. Available at: https://webappa.cdc.gov/sasweb/ncipc/mortrate.html. (Accessed April 12 2024).

      Not checked in the free run.

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

    Premisecitation

    In the 2021 Youth Risk Behavior Survey, 22% of US high school students reported seriously considering suicide and 10% reported attempting suicide at least once in the prior 12 months.

    “According to the 2021 Youth Risk Behavior Survey of U.S. high school students, 22% of youth indicated they seriously considered suicide, and 10% of youth reported they attempted suicide at least once in the prior 12 month.4”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [4] Centers for Disease Control and Prevention. Youth risk behavior survey data summary & trends report: 2011 - 2021 2023. Available at: https://www.cdc.gov/healthyyouth/data/yrbs/pdf/YRBS_Data-Summary-Trends_Report2023_508.pdf. (Accessed April 13 2024).

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Suicidal ideation and suicide attempts have increased substantially among youth.

    “Suicidal ideation, defined as thoughts of ending one’s life, and suicide attempts, a non-fatal self-injurious behavior with stated or inferred intent to die, have also increased substantially in youth”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [3] O'Carroll, 1996, Beyond the tower of Babel: A nomenclature for suicidology, Suicide Life-Threatening Behav source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Primary care practices are a major point of contact for healthcare services and for youth at risk of suicide, and in some cases serve as the de facto mental health care setting.

    “Primary care practices are a major point of contact for healthcare services and youth who may be at risk for suicide, and in some cases the de facto mental health care setting.5”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [5] Campo, 2009, Youth suicide prevention: Does access to care matter?, Curr Opin Pediatr source

      Not checked in the free run.

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

    Premisecitation

    Suicide rates among US youth aged 10-19 increased 27% between 2011 and 2022, from 4.9 to 6.3 per 100,000.

    “suicide rates in this age group increased 27% between 2011 and 2022 (from 4.9 to 6.3 per 100,000).2”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [2] Centers for Disease Control and Prevention. Web-based Injury Statistics Query and Reporting System (WISQARS) Fatal Death Reports [online]. National Center for Injury Prevention and Control. Available at: https://webappa.cdc.gov/sasweb/ncipc/mortrate.html. (Accessed April 12 2024).

      Not checked in the free run.

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

    Premisecitation

    Females aged 10-14 had the sharpest increase in suicide rates, which more than doubled from 0.8 to 1.9 per 100,000 during 2012-2022.

    “females aged 10-14 years showed the sharpest increase, with suicide rates more than doubling during this timeframe (from 0.8 to 1.9 per 100,000).2”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [2] Centers for Disease Control and Prevention. Web-based Injury Statistics Query and Reporting System (WISQARS) Fatal Death Reports [online]. National Center for Injury Prevention and Control. Available at: https://webappa.cdc.gov/sasweb/ncipc/mortrate.html. (Accessed April 12 2024).

      Not checked in the free run.

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

    Premisecitation

    Suicide rates among youth aged 15-19 increased 20% between 2012 and 2022, from 8.3 to 10.0 per 100,000.

    “compared to a 20% increase in youth aged 15-19 years (from 8.3 to 10.0 per 100,000)2”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [2] Centers for Disease Control and Prevention. Web-based Injury Statistics Query and Reporting System (WISQARS) Fatal Death Reports [online]. National Center for Injury Prevention and Control. Available at: https://webappa.cdc.gov/sasweb/ncipc/mortrate.html. (Accessed April 12 2024).

      Not checked in the free run.

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

    Premisecitation

    Suicide rates among youth aged 10-14 increased 59% between 2012 and 2022, from 1.4 to 2.4 per 100,000.

    “suicide rates among youth aged 10-14 years increased 59% between 2012 and 2022 (from 1.4 to 2.4 per 100,000)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [2] Centers for Disease Control and Prevention. Web-based Injury Statistics Query and Reporting System (WISQARS) Fatal Death Reports [online]. National Center for Injury Prevention and Control. Available at: https://webappa.cdc.gov/sasweb/ncipc/mortrate.html. (Accessed April 12 2024).

      Not checked in the free run.

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

    Premisecitation

    Suicide is a leading cause of death among US youth aged 10-19, and in 2022 it accounted for 23% of deaths in this age group.

    “Suicide is a leading cause of death among youth aged 10-19 years in the United States and in 2022 accounted for 23% of all deaths in this age group.1”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [1] Centers for Disease Control and Prevention, Web-based Injury Statistics Query and Reporting System (WISQARS) Leading Cause of Death [online]. National Center for Injury Prevention and Control. Available at: https://wisqars.cdc.gov/lcd/?o=LCD&y1=2021&y2=2021&ct=10&cc=. (Accessed April 7 2024).

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Suicidal ideation and suicide attempts are strong predictors of future suicide in youth.

    “and are strong predictors of future suicide.3”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [3] O'Carroll, 1996, Beyond the tower of Babel: A nomenclature for suicidology, Suicide Life-Threatening Behav source

      Not checked in the free run.

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

    Premisecitation

    From 2018-2022, the suicide rate among AI/AN youth aged 10-19 was 25.8 per 100,000, three times the White youth rate of 7.8 per 100,000 and over four times the rates for Black, Asian/Pacific Islander, and Hispanic youth.

    “From 2018-2022, the suicide rate among AI/AN youth aged 10-19 years in the U.S. (25.8 per 100,000) was 3 times the rate for White youth (7.8 per 100,000), and over 4 times higher than rates for Black, Asian/Pacific Islander, and Hispanic youth.2”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [2] Centers for Disease Control and Prevention. Web-based Injury Statistics Query and Reporting System (WISQARS) Fatal Death Reports [online]. National Center for Injury Prevention and Control. Available at: https://webappa.cdc.gov/sasweb/ncipc/mortrate.html. (Accessed April 12 2024).

      Not checked in the free run.

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

    Premisecitation

    Recent data show a narrowing gap between male and female youth suicide rates.

    “However, recent data reveals a narrowing gap between male and female youth suicide.2,13”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [2] Centers for Disease Control and Prevention. Web-based Injury Statistics Query and Reporting System (WISQARS) Fatal Death Reports [online]. National Center for Injury Prevention and Control. Available at: https://webappa.cdc.gov/sasweb/ncipc/mortrate.html. (Accessed April 12 2024).

      Not checked in the free run.

    • cites [13] Ruch, 2019, Trends in Suicide Among Youth Aged 10 to 19 Years in the United States, 1975 to 2016, JAMA Netw Open source

      Not checked in the free run.

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

    Premisecitation

    The suicide rate in children younger than 13 is roughly two times higher for Black children than White children.

    “Bridge et al,14 found the suicide rate in children younger than 13 years to be roughly two times higher for Black children compared with White children.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [14] Bridge, 2018, Age-related racial disparity in suicide rates among US youths from 2001 through 2015, JAMA Pediatr source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Identifying youth at risk for suicide in pediatric primary care is important, and this setting is essential for improving youth mental and behavioral health.

    “Evidence highlights the importance of identifying youth at risk for suicide in pediatric primary care and suggests this is an essential setting for improving youth mental and behavioral health.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Many youth prefer to see their primary care provider for emotional problems because there is less stigma and greater accessibility.

  • May combine two claims.

    Premisecitation

    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”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [16] Horowitz, 2021, Screening pediatric medical patients for suicide risk: Is depression screening enough?, J Adolesc Health source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    A 2019 AAP survey found that over 90% of pediatricians had a patient screen positive or disclose suicidal ideation, and 81% reported having a patient who attempted or died by suicide.

    “A 2019 survey by the American Academy of Pediatrics (AAP) found over 90% of pediatricians had a patient screen positive or disclose suicide ideation, and 81% reported having a patient who attempted or died by suicide.6”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [6] Green, 2023, A national survey of pediatricians' experiences and practices with suicide prevention, Acad Pediatr source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    About 80% of suicide decedents are seen by primary care providers in the year before death, while only 20% have contact with a mental health professional.

    “Research further shows approximately 80% of suicide decedents are seen by primary care providers in the year prior to death, while only 20% have contact with a mental health professional.7,8”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [7] Ahmedani, 2014, Health care contacts in the year before suicide death, J Gen Intern Med source

      Not checked in the free run.

    • cites [8] Luoma, 2002, Contact with mental health and primary care providers before suicide: A review of the evidence, Am J Psychiatr source

      Not checked in the free run.

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

    Premisecitation

    The AAP recommends that primary care providers screen and assess for suicide risk, become educated on managing certain mental health conditions, and link patients to specialized care and follow-up services.

    “The AAP also recommends that primary care providers not only screen and assess for suicide risk, but also become educated on how to manage certain mental health conditions and more effectively link patients to necessary specialized care and follow up services.11”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [11] Shain, 2016, Suicide and Suicide Attempts in Adolescents, Pediatrics source

      Not checked in the free run.

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

    Premisecitation

    In 2022, 19.5% of US youth aged 12-17 experienced a past-year major depressive episode.

    “a national survey shows 19.5% of youth aged 12-17 years experienced a past year major depressive episode in 2022.20”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [20] SAMHSA, National survey on drug use and health (NSDUH) 2023. Available at: https://www.samhsa.gov/data/release/2022-national-survey-drug-use-and-health-nsduh-releases, (Accessed May 3 2024). 2022.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Up to 25% of studies in a review suggested positive aspects of social media/internet use, with youth with a history of suicidal behavior using the internet for support and community.

    “In an additional review, up to 25% of studies suggested positive aspects of social/media internet use, revealing youth with a history of suicidal behavior used the internet as a form of support and sense of community to seek help and connect with others.33”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [33] Marchant, 2017, A systematic review of the relationship between internet use, self-harm and suicidal behaviour in young people: The good, the bad and the unknown, PLoS One source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    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”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [16] Horowitz, 2021, Screening pediatric medical patients for suicide risk: Is depression screening enough?, J Adolesc Health source

      Not checked in the free run.

    • cites [38] Kemper, 2021, Depression and suicide-risk screening results in pediatric primary care, Pediatrics

      Not checked in the free run.

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

    Premisecitation

    Following a positive screen, assessment is a comprehensive evaluation typically conducted by a medical provider or mental health clinician to obtain specific information about risk and protective factors and guide next steps.

    “Following a positive screen, assessment is a comprehensive evaluation, typically conducted by a medical provider or mental health clinician, to obtain more specific information about risk and protective factors, including diagnostic and psychosocial considerations, to guide next steps.46,47”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [46] Hughes, 2023, Suicide in young people: Screening, risk assessment, and intervention, BMJ

      Not checked in the free run.

    • cites [47] Busby, 2023, Measurement choices for youth suicidality, Child Psychiatry Hum Dev source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    A yes response or nonresponse to any ASQ initial question yields a positive suicide risk screen and prompts a fifth question to assess acuity.

    “A “yes” response or nonresponse to any of these questions results in a positive screening result for suicide risk, and prompts a fifth question to assess acuity.40”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [40] Horowitz, 2012, Ask Suicide-Screening Questions (ASQ): A brief instrument for the pediatric emergency department, Arch Pediatr Adolesc Med source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    The Blueprint for Youth Suicide Prevention calls for universal suicide risk screening in youth ages 12 and older in primary care and other clinical settings.

    “In the Blueprint for Youth Suicide Prevention, the AAP and the American Foundation for Suicide Prevention, in collaboration with the National Institute of Mental Health (NIMH), more specifically call for universal suicide risk screening in youth ages 12 years and older in primary care and other clinical settings.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    The ASQ is an evidence-based screening tool developed specifically for youth in medical settings.

    “One such evidence-based screening tool developed specifically for youth in medical settings is the Ask Suicide-Screening Questions (ASQ).39,40”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [39] Aguinaldo, 2021, Validation of the ask suicide-screening questions (ASQ) with youth in outpatient specialty and primary care clinics, Gen Hosp Psychiatry source

      Not checked in the free run.

    • cites [40] Horowitz, 2012, Ask Suicide-Screening Questions (ASQ): A brief instrument for the pediatric emergency department, Arch Pediatr Adolesc Med source

      Not checked in the free run.

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

    Premisecitation

    The SAFE-T has frequently been used in primary care training and practice, though it was not included as a suggested suicide risk assessment tool by the AACAP PaCC Workgroup.

    “The SAFE-T has frequently been used in primary care training and practice, though was not included as a suggested suicide risk assessment tool by the American Academy of Child and Adolescent Psychiatry (AACAP) Pathways in Clinical Care (PaCC) Workgroup.50”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [50] Brahmbhatt, 2019, Suicide risk screening in pediatric hospitals: clinical pathways to address a global health crisis, Psychosomatics source

      Not checked in the free run.

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

    Premisenone given

    For younger youth, guidelines suggest screening if there are warning signs of suicide risk or parental reports of youth suicidal thoughts and behaviors.

    “For younger youth, guidelines suggest screening if there are warning signs of suicide risk or parental reports of youth suicidal thoughts and behaviors.”
    Quote in the paperNot a substantial claim

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

    Premisenone given

    The AAP recommends screening youth aged 8-11 when clinically indicated, such as for mental health concerns or known history of suicidal thoughts and behaviors.

    “The AAP further recommends youth aged 8-11 years be screened when clinically indicated, such as presenting with mental health concerns, or if there is a known history of suicidal thoughts and behaviors.”
    Quote in the paperNot a substantial claim

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

    Premisecitation

    Positive peer influence is effective in school-based suicide prevention programs.

    “however positive peer influence is shown to be effective in school-based suicide prevention programs.30,31”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [30] Katz, 2013, A systematic review of school-based suicide prevention programs. Research Support, Non-U.S. Gov't Review, Depress Anxiety

      Not checked in the free run.

    • cites [31] Singer, 2019, School-based suicide prevention: A framework for evidence-based practice, School Mental Health

      Not checked in the free run.

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

    Premisecitation

    The AAP recommends annual depression screening for all pediatric patients and inquiry about factors associated with elevated suicide risk.

    “The AAP recommends that all pediatric patients be screened for depression annually, and to also inquire about factors shown to be associated with elevated suicide risk.11”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [11] Shain, 2016, Suicide and Suicide Attempts in Adolescents, Pediatrics source

      Not checked in the free run.

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

    Premisenone given

    The C-SSRS is a tool to aid providers in assessing detailed suicide risk elements including ideation, intensity of ideation, suicidal behaviors and preparation, and lethality.

    “The C-SSRS (http://www.cssrs.columbia.edu/) is a tool to aid providers/clinicians in assessing more detailed suicide risk elements, including suicidal ideation, the intensity of suicidal ideation (including frequency, duration, controllability, deterrents, and reasons for ideation), suicidal behaviors and preparation (including actual attempts, interrupted attempts, aborted attempts, and prepar”
    Quote in the paperNot a substantial claim

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

    Premisereasoning

    The SAFE-T was developed from APA practice guidelines and includes a five-step process.

    “The SAFE-T, developed from the American Psychiatric Association Practice Guidelines for the Assessment and Treatment of Patients with Suicidal Behaviors, includes a five-step process:”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Studies show the ASQ has high sensitivity, specificity, and negative predictive validity, and can detect patients at risk for suicide that depression screening alone fails to identify.

    “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”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [40] Horowitz, 2012, Ask Suicide-Screening Questions (ASQ): A brief instrument for the pediatric emergency department, Arch Pediatr Adolesc Med source

      Not checked in the free run.

    • cites [41] Ballard, 2017, Identification of at-risk youth by suicide screening in a pediatric emergency department, Prev Sci source

      Not checked in the free run.

    • cites [42] DeVylder, 2019, Assessment of selective and universal screening for suicide risk in a pediatric emergency department, JAMA Netw Open source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The C-SSRS has demonstrated convergent validity with established suicidal ideation and behavior scales and strong divergent validity with depression scales.

    “The C-SSRS has demonstrated convergent validity with established suicidal ideation and behavior scales and strong divergent validity with depression scales.47”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [47] Busby, 2023, Measurement choices for youth suicidality, Child Psychiatry Hum Dev source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductcitation

    There are no psychometric validation studies of the BSSA at this time, though providers have reported the approach is acceptable.

    “There are no psychometric validation studies of the BSSA at this time, though providers have reported this approach is acceptable.47-49”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [47] Busby, 2023, Measurement choices for youth suicidality, Child Psychiatry Hum Dev source

      Not checked in the free run.

    • cites [48] Christensen LeCloux, 2022, J Behav Health Serv Res source

      Not checked in the free run.

    • cites [49] Snyder, 2020, From pilot to practice: Implementation of a suicide risk screening program in hospitalized medical patients, Jt Comm J Qual Patient Saf

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    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”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [16] Horowitz, 2021, Screening pediatric medical patients for suicide risk: Is depression screening enough?, J Adolesc Health source

      Not checked in the free run.

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

    Premisecitation

    Previous research suggests suicidal behaviors are influenced by affiliation with peers who have engaged in suicidal behaviors.

    “Previous research also suggests suicidal behaviors are influenced by affiliation with peers who have engaged in suicidal behaviors,29”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [29] Mueller, 2015, Suicidal disclosures among friends: Using social network data to understand suicide contagion, J Health Soc Behav source

      Not checked in the free run.

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

    Premisenone given

    The BSSA was developed as a brief 15-minute tool to aid clinicians in classifying risk and determining next steps in care.

    “The BSSA was developed as a brief (15 minute) tool for clinicians/providers to aid in classification of risk to guide determining the next steps in care.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    FISP is included as an evidence-based intervention by SPRC/AFSP and is an enhanced mental health intervention involving a family-based CBT session in the ED.

    “FISP, also included as an evidence-based intervention by SPRC/AFSP , is an enhanced mental health intervention involving a family-based CBT session in the ED designed to increase motivation for follow-up treatment, support, coping, and safety.53”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [53] Asarnow, 2011, An emergency department intervention for linking pediatric suicidal patients to follow-up mental health treatment, Psychiatr Serv source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Evidence points to high patient satisfaction, enhanced understanding of diagnoses and treatments, and greater patient empowerment through navigation.

    “In addition, evidence points to high patient satisfaction, enhanced understanding of diagnoses and treatments, and greater patient empowerment through navigation.88”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [88] Godoy, 2019, Increasing mental health engagement from primary care: The potential role of family navigation, Pediatrics source

      Not checked in the free run.

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

    Premisecitation

    In SPI, the safety plan is a hierarchically arranged written list of coping strategies and sources of support for use in a suicidal crisis or to avert one.

    “In SPI, the safety plan is a hierarchically arranged, written list of coping strategies and sources of support that the adolescent can use in a suicidal “crisis” or to avert such a crisis.61”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [61] Stanley, 2012, Safety planning intervention: A brief intervention to mitigate suicide risk, Cognit Behav Pract source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Studies on adult populations with conditions like cancer or severe mental illness show care navigation leads to increased health services utilization, including improved linkages to care, adherence to treatment recommendations, and timeliness in accessing health services.

    “studies on adult populations with conditions like cancer or severe mental illness have shown that care navigation leads to increased health services utilization, including improved linkages to care, adherence to treatment recommendations, and timeliness in accessing health services.88”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [88] Godoy, 2019, Increasing mental health engagement from primary care: The potential role of family navigation, Pediatrics source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Asarnow and colleagues demonstrated that FISP could effectively link youth and parents to care and was delivered in the ED setting in 80.9% of patients.

    “Asarnow and colleagues53 demonstrated that a brief family-based ED intervention, the Family Intervention for Suicide Prevention (FISP), could effectively link youth and parents to care and this intervention was effectively delivered in the ED setting in 80.9% of patients54.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [53] Asarnow, 2011, An emergency department intervention for linking pediatric suicidal patients to follow-up mental health treatment, Psychiatr Serv source

      Not checked in the free run.

    • cites [54] Hughes, 2013, Enhanced mental health interventions in the emergency department: Suicide and suicide attempt prevention in the ED, Clin Pediatr Emerg Med source

      Not checked in the free run.

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

    Premisecitation

    SPI was initially developed as part of the CBT-SP intervention in the NIMH-funded Treatment of Adolescent Suicide Attempters study.

    “SPI was initially developed as part of the CBT-SP intervention in the NIMH-funded Treatment of Adolescent Suicide Attempters (TASA) study.62,60”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [62] Brent, 2009, The treatment of adolescent suicide attempters study (TASA): Predictors of suicidal events in an open treatment trial, J Am Acad Child Adolesc Psychiatry source

      Not checked in the free run.

    • cites [60] Stanley, 2009, Cognitive-behavioral therapy for suicide prevention (CBT-SP): Treatment model, feasibility, and acceptability, J Am Acad Child Adolesc Psychiatry source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In the same FISP trial, the intervention group had a significantly higher rate of psychotherapy, combined psychotherapy/medication, and more psychotherapy visits.

    “The intervention group also had a significantly higher rate of psychotherapy, combined psychotherapy/medication, and more psychotherapy visits”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [53] Asarnow, 2011, An emergency department intervention for linking pediatric suicidal patients to follow-up mental health treatment, Psychiatr Serv source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Brief youth suicide prevention interventions have been most robustly tested in emergency department settings, despite holding strong potential for effectiveness and current use across a wide variety of care settings and providers.

    “Brief youth suicide prevention interventions have been most robustly tested in ED settings, despite holding strong potential for effectiveness and current use across a wide variety of care settings, through implementation by a wide variety of care providers.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Brief youth suicide prevention interventions have strong potential for effectiveness and are currently used across a wide variety of care settings and providers.

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

    Premisecitation

    Care navigators aim to support families by ensuring ongoing access to care, promoting engagement with care, facilitating shared decision making with providers, and increasing awareness of community resources.

    “Care navigators, who may be clinicians, peers, or paraprofessionals, aim to support families by ensuring ongoing access to care, promoting engagement with care, facilitating shared decision making with providers, and increasing awareness of community resources.87”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [87] McDonald, 2007

      Not checked in the free run.

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

    Premisenone given

    The AAP, SPRC, and the National Institute for Health and Care Excellence recommend safety planning for youth presenting with elevated suicide risk.

    “The AAP, SPRC, and the National Institute for Health and Care Excellence recommend safety planning for youth presenting with elevated suicide risk.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Follow-up interventions are typically brief (6-12 sessions), low cost, nondemand interventions that can be conducted by anyone and occur on a structured schedule over a designated period.

    “In contrast to other resource intensive suicide-specific interventions that require a mental health specialist, follow-up interventions are typically brief (6-12 sessions), low cost, nondemand interventions that can be conducted by anyone and occur according to a structured schedule over a designated period (e.g., 1 year).77,78”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [77] Milner, 2015, Letters, green cards, telephone calls and postcards: Systematic and meta-analytic review of brief contact interventions for reducing self-harm, suicide attempts and suicide, Br J Psychiatry source

      Not checked in the free run.

    • cites [78] Stanley, 2023, Brief and ultra-brief suicide-specific interventions, FOCUS source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Safety plans increase self-efficacy and coping.

    “Safety plans do increase self-efficacy and coping.57,58”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [57] Czyz, 2019, Motivational interviewing-enhanced safety planning for adolescents at high suicide risk: A pilot randomized controlled trial, J Clin Child Adolesc Psychol source

      Not checked in the free run.

    • cites [58] Micol, 2022, Enhancing motivation and self-efficacy for safety plan use: Incorporating motivational interviewing strategies in a brief safety planning intervention for adolescents at risk for suicide, Psychotherapy source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Ensuring timely, seamless, uninterrupted follow-up care as youth transition between health settings has the potential to save lives and reduce suicide attempts.

    “Ensuring that youth at risk for suicide receive timely, seamless, uninterrupted follow-up care as they transition from one health setting to another has the potential to save lives and reduce suicide attempts.75”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [75] Zalsman, 2016, Suicide prevention strategies revisited: 10-year systematic review, Lancet Psychiatr source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Clinical pathways can have positive impact on quality of care, population health, workflow of frontline providers, and processes within health care organizations.

    “Clinical pathways can have positive impact on the quality of care delivered to individual patients, on the health of populations of patients with particular diseases or conditions, on the workflow of frontline providers, and on processes within the health care organization.90,91”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [90] Rotter, 2013, Clinical pathways for primary care: effects on professional practice, patient outcomes, and costs, Cochrane Database Syst Rev

      Not checked in the free run.

    • cites [91] Rotter, 2010, Clinical pathways: Effects on professional practice, patient outcomes, length of stay and hospital costs, Cochrane Database Syst Rev

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Although randomized clinical trials on follow-up interventions for suicidal patients are scarce, existing research generally suggests follow-up contacts may reduce repeat suicide attempts and prevent death by suicide for patients discharged from inpatient or emergency departments.

    “Although there is a paucity of randomized clinical trials on follow-up interventions for suicidal patients, existing research generally suggests that follow-up contacts may reduce repeat suicide attempts and prevent death by suicide for patients discharged from inpatient or emergency departments.76,79,80”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [76] Brown, 2014, A review of evidence-based follow-up care for suicide prevention: Where do we go from here?, Am J Prev Med source

      Not checked in the free run.

    • cites [79] Luxton, 2013, Can postdischarge follow-up contacts prevent suicide and suicidal behavior?, Crisis source

      Not checked in the free run.

    • cites [80] Ghanbari, 2015, Suicide prevention and follow-up services: A narrative review, Global J Health Sci source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    Safety plans appear to support behavior change for suicide prevention but may not impact levels of cognitive distress related to suicidal ideation.

    “Safety plans appear to support behavior change for suicide prevention but may not impact levels of cognitive distress related to suicidal ideation.56”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [56] McCabe, 2018, Effectiveness of brief psychological interventions for suicidal presentations: a systematic review, BMC Psychiatr source

      Not checked in the free run.

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

    Premisecitation

    The American Board of Pediatrics and the AAP have called for increased training of pediatricians in managing behavioral and mental health concerns, and the AAP developed an educational resource for youth suicide prevention.

    “The American Board of Pediatrics (ABP) and the AAP have called for increased training of pediatricians in managing patients with behavioral and mental health concerns, with the AAP specifically developing an educational resource for youth suicide prevention: “Suicide: Blueprint for Youth Suicide Prevention.”73”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [73] American Academy of Pediatrics. American Foundation for Suicide Prevention. National Institute of Mental Health. Suicide: Blueprint for Youth Suicide Prevention. Available at: https://www.aap.org/en/patient-care/blueprint-for-youth-suicide-prevention/. (Accessed April 4 2024).

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Motivational interviewing strategies may enhance adherence to youth safety plan use and parents' motivation to encourage safety plan use.

    “Motivational interviewing strategies, which are often used to address health behavior change in pediatric primary care, may enhance adherence to youth safety plan use and parents’ motivation to encourage safety plan use.57,58”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [57] Czyz, 2019, Motivational interviewing-enhanced safety planning for adolescents at high suicide risk: A pilot randomized controlled trial, J Clin Child Adolesc Psychol source

      Not checked in the free run.

    • cites [58] Micol, 2022, Enhancing motivation and self-efficacy for safety plan use: Incorporating motivational interviewing strategies in a brief safety planning intervention for adolescents at risk for suicide, Psychotherapy source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    The National Action Alliance for Suicide Prevention's Clinical Care and Intervention Task Force recommends including follow-up care for patients at risk for suicide leaving care or transitioning between settings as one of four components of evidence-based suicide prevention care.

    “Based on this evidence, the National Action Alliance for Suicide Prevention’s Clinical Care and Intervention Task Force has recommended the inclusion of follow-up care for those patients at risk for suicide leaving care or transitioning from one health setting to another as one of the four components of evidenced based suicide prevention care.86”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [86] Covington, 2011, Suicide care in systems framework. National Action Alliance, Clinical Care & Intervention Task Force

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Multiple randomized controlled trials of adolescents with depression in primary care have shown that collaborative care models reduce depression and increase adherence to evidence-based treatments.

    “Additionally, several randomized controlled trials focusing on adolescents with depression in primary care settings have demonstrated the effectiveness of CCMs in decreasing depression and improving adherence to evidenced-base treatments.107-110”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [107] Asarnow, 2005, Effectiveness of a quality improvement intervention for adolescent dpression in primary care clinics, JAMA source

      Not checked in the free run.

    • cites [108] Wells, 2012, Treatment of youth depression in primary care under usual practice conditions: Observational findings from youth partners in care, J Child Adolesc Psychopharmacol source

      Not checked in the free run.

    • cites [109] Asarnow, 2009, Long-term benefits of short-term quality improvement interventions for depressed youths in primary care, Am J Psychiatr source

      Not checked in the free run.

    • cites [110]

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    Follow-up care inside and outside primary care is necessary for patients who screen positive for suicide risk, to maintain continuity and prevent later suicidal behavior and suicide.

    “Follow-up care both within and outside the primary care clinic is essential for patients who screen positive for suicide risk to ensure continuity of care and prevent future suicide behavior and suicide.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Premisenone given

    The clinical pathway was created as an evidence-informed guide to improve risk screening and manage screen-positive patients using the ASQ and BSSA for screening and risk stratification.

    “The pathway was created as an evidence-informed guide to improve risk screening and effectively manage screen positive patients using the ASQ and the BSSA for screening and risk stratification (ASQ toolkit).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Within primary care, 20%-40% of adolescents have high levels of distress or suicidal ideation, yet PCPs identify less than half.

    “Within primary care, 20%-40% of adolescents have high levels of distress or suicidal ideation, yet PCPs identify less than half.94-96”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [94] Ozer, 2009, Are adolescents being screened for emotional distress in primary care?, J Adolesc Health source

      Not checked in the free run.

    • cites [95] McKelvey, 1998, Psychological distress and suicidal ideation among 15-24-year-olds presenting to general practice: A pilot study, Aust N Z J Psychiatry source

      Not checked in the free run.

    • cites [96] Pfaff, 2001, Training general practitioners to recognise and respond to psychological distress and suicidal ideation in young people, Med J Aust source

      Not checked in the free run.

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

    Premisenone given

    Caring contacts, such as phone calls or texts within 72 hours after the initial visit, can effectively reduce suicidal behavior.

    “As previously discussed (see section on follow-up and monitoring), caring contacts (including following up phone calls or texts within 72 hours of the initial visit) can be an effective strategy for reducing suicidal behavior.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Suicide prevention and management strategies have been implemented by some organizations but have not been widely applied, with high variability in care delivery across providers and settings.

    “Suicide prevention and management strategies have been implemented by some organizations but have not been widely applied and there is a high degree of variability in care delivery across providers and settings.92”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [92] Hogan, 2016, Suicide prevention: An emerging priority for health care, Health Aff source

      Not checked in the free run.

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

    Premisecitation

    The outpatient clinical pathway for screening was developed by the AACAP PaCC workgroup to assist hospitals, EDs, and inpatient units implementing suicide risk screening, with subsequent versions for outpatient primary and specialty care modified by NIMH.

    “The outpatient clinical pathway was developed by the Pathways in Clinical Care (PaCC) workgroup from within the Physically 111 Child committee of the AACAP to assist hospitals and EDS, and inpatient medical/surgical units implementing suicide risk screening to pediatric patients,98 with subsequent versions developed for outpatient primary and specialty care modified by NIMH.99”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [98] Horowitz, 2022, Implementing suicide risk screening in a pediatric primary care setting: From research to practice, Acad Pediatr source

      Not checked in the free run.

    • cites [99] Ayer, 2022, Clinical pathway for suicide risk screening in adult primary care settings: Special recommendations, J Acad Consult Liaison Psychiatry source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Care managers are important for coordinating interventions, aiding decision-making and communication between patients and primary care providers, tracking mental health symptoms and medication use, and promoting treatment adherence.

    “Care managers play a vital role in coordinating interventions, supporting decision-making and communication between the patient and the PCP, monitoring mental health symptoms and medication use, and ensuring treatment adherence.104”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [104] Bruce, 2004, Reducing suicidal ideation and depressive symptoms in depressed older primary care patients: A randomized controlled trial, JAMA source

      Not checked in the free run.

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

    Premisecitation

    Similar clinical pathways have been developed for adult populations.

    “Similar pathways have been developed for adult populations.100”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [100] Schoen, 2019, Suicide risk assessment and management training practices in pediatric residency programs: A nationwide needs assessment survey, J Adolesc Health source

      Not checked in the free run.

66 of 66

  • The paper relies on this without support.

    Many youth prefer to see their primary care provider for emotional problems because there is less stigma and greater accessibility.

    “Also, many youth would prefer to see their primary care provider concerning emotional problems, as there is less stigma and more accessibility.”

  • The paper relies on this without support.

    Accessing specialty mental health care is difficult and treatment dropout rates are high.

    “Given the difficulties in accessing specialty mental health care and the high treatment dropout rates, pediatric primary care is the setting in which many youth with recent suicidal crises are likely to present.”

  • The paper relies on this without support.

    Suicide is closely linked with depression, and depression screening is often the gateway to suicide prevention in primary care.

    “Suicide is closely linked with depression, and screening for depression is often the gateway to suicide prevention in primary care settings.”

  • The paper relies on this without support.

    Brief youth suicide prevention interventions have strong potential for effectiveness and are currently used across a wide variety of care settings and providers.

    “despite holding strong potential for effectiveness and current use across a wide variety of care settings, through implementation by a wide variety of care providers.”

  • The paper relies on this without support.

    Primary care providers are at the forefront of suicide prevention.

    “Despite being at the forefront of suicide prevention, recent surveys suggest that PCPs often lack adequate training in suicide prevention and intervention strategies.101-103”

  • The paper relies on this without support.

    No studies have examined how well collaborative care models work on suicidal behaviors among pediatric populations.

    “Although no studies have evaluated the effectiveness of CCM on suicidal behaviors in pediatric populations, research on older adults has shown that CCMs can significantly reduce suicidal ideation and symptoms of depression.105,106”
6 of 6

Cites

Flagged first, then by citations

Research works printed but not linked: 1

  1. Covington, 2011, Suicide care in systems framework. National Action Alliance, Clinical Care & Intervention Task Force

Cited by

Sorted by citations

Related

Authors
Ruch, D. A., Hughes, J. L., Bridge, J. A., & Fontanella, C. A.
Affiliations
Nationwide Children's Hospital (US)
Corresponding author
Ruch, Donna A.
ORCID
Venue
Pediatric Clinics of North America
Publisher
Elsevier BV
Published
2024-12
Volume
71
Issue
6
Pages
1119-1140
ISSN
0031-3955 (ISSN-L)
DOI
10.1016/j.pcl.2024.07.017
PMC
PMC11494147
OpenAlex
W4401843883
Semantic Scholar
36892dcfdc725f7de1da568028259dfc2ea3aea7
Cited by
10
References
104
Citations by year
2026: 4 · 2025: 6
FWCI
0.89
Type
journal article
Language
en
Open access
Licence
Locations
  • Pediatric Clinics of North America (acceptedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Institute of Mental Health
  • National Institutes of Health
Topics
  • Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Injury Epidemiology and Prevention
  • Social Sciences › Health › Gun Ownership and Violence Research
Keywords
youth suicide, suicide prevention, pediatric primary care, suicide risk screening, suicide risk assessment, suicide intervention, follow-up care, youth mental health, suicide epidemiology, suicide prevention education
MeSH terms
Suicide Prevention, Adolescent, Child, Humans, Mass Screening, Pediatrics, Primary Health Care, Risk Factors, Suicide, United States, Risk Assessment, Evidence-Based Medicine

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-09.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-09.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review