Elizabeth A. Wharff

Ask Suicide-Screening Questions (ASQ): A brief instrument for the pediatric emergency department

OBJECTIVE To develop a brief screening instrument to assess the risk for suicide in pediatric emergency department patients. DESIGN A prospective, cross-sectional instrument-development study evaluated 17 candidate screening questions assessing suicide risk in young patients. The Suicidal Ideation Questionnaire served as the criterion standard. SETTING Three urban, pediatric emergency departments associated with tertiary care teaching hospitals. PARTICIPANTS A convenience sample of 524 patients aged 10 to 21 years who presented with either medical/surgical or psychiatric chief concerns to the emergency department between September 10, 2008, and January 5, 2011. MAIN EXPOSURES Participants answered 17 candidate questions followed by the Suicidal Ideation Questionnaire. MAIN OUTCOME MEASURES Sensitivity, specificity, predictive values, likelihood ratios, and area under the receiver operating characteristic curves of the best-fitting combinations of screening questions for detecting elevated risk for suicide. RESULTS A total of 524 patients were screened (344 medical/surgical and 180 psychiatric). Fourteen of the medical/surgical patients (4%) and 84 of the psychiatric patients (47%) were at elevated suicide risk on the Suicidal Ideation Questionnaire. Of the 17 candidate questions, the best-fitting model comprised 4 questions assessing current thoughts of being better off dead, current wish to die, current suicidal ideation, and past suicide attempt. This model had a sensitivity of 96.9% (95% CI, 91.3-99.4), specificity of 87.6% (95% CI, 84.0-90.5), and negative predictive values of 99.7% (95% CI, 98.2-99.9) for medical/surgical patients and 96.9% (95% CI, 89.3-99.6) for psychiatric patients. CONCLUSIONS A 4-question screening instrument, the Ask Suicide-Screening Questions (ASQ), with high sensitivity and negative predictive value, can identify the risk for suicide in patients presenting to pediatric emergency departments.

Patients’ Opinions About Suicide Screening in a Pediatric Emergency Department

Objective Understanding how children react to suicide screening in an emergency department (ED) can inform implementation strategies. This qualitative study describes pediatric patients’ opinions regarding suicide screening in that setting. Methods As part of a multisite instrument validation study, patients 10 to 21 years presenting with both psychiatric and nonpsychiatric complaints to an urban, tertiary care pediatric ED were recruited for suicide screening. Interviews with subjects included the question, “do you think ER nurses should ask kids about suicide/thoughts about hurting themselves…why/why not?” Responses were transcribed verbatim and uploaded into NVivo8.0 qualitative software for coding and content analysis. Results Of the 156 patients who participated in the study, 106 (68%) presented to the ED with nonpsychiatric complaints and 50 (32%) presented with psychiatric complaints. The patients’ mean (SD) age was 14.6 (2.8) years (range, 10–21 years), and 56% of the sample was female. All patients answered the question of interest, and 149 (96%) of 156 patients supported the idea that nurses should ask youth about suicide in the ED. The 5 most frequently endorsed themes were as follows: (1) identification of youth at risk (31/156, 20%), (2) a desire to feel known and understood by clinicians (31/156, 20%), (3) connection of youth with help and resources (28/156, 18%), (4) prevention of suicidal behavior (25/156, 16%), and (5) lack of other individuals to speak with about these issues (19/156, 12%). Conclusions Pediatric patients in the ED support suicide screening after being asked a number of suicide-related questions. Further work should evaluate the impact of suicide screening on referral practices and link screening efforts with evidence-based interventions.

A Pilot Study of the Acceptability and Usability of a Smartphone Application Intervention for Suicidal Adolescents and Their Parents

Interconnectedness through technology presents both challenges and opportunities for suicide prevention and intervention with adolescents and families. The time following discharge from acute care facilities represents a critical period of suicide risk for adolescents, which could be buffered by a technological intervention they could use post-discharge. Crisis Care is a smartphone application intervention developed specifically for suicidal adolescents and their parents to use during this period of increased risk. A web-based prototype of Crisis Care was pilot tested with 20 adolescent-parent dyads. Results demonstrated acceptability and usability, suggesting the utility of technological interventions, such as Crisis Care, as an adjunct to treatment for suicidal adolescents and their parents following discharge from acute care settings.

Field Note—Developing Suicide Risk Assessment Training for Hospital Social Workers: An Academic–Community Partnership

This article describes 1 large urban pediatric hospitals partnership with a university to provide suicide assessment and management training within its social work department. Social work administrators conducted a department-wide needs assessment and implemented a 2-session suicide assessment training program and evaluation. Respondents (97.8%) indicated that the training was either helpful or very helpful in 8 suicide assessment skill-based domains. All attendees reported positive changes in perceived competence in 6 of 8 skill-based domains. A brief and time-efficient in-service training can be instrumental in augmenting hospital social worker competence in suicide risk assessment practice. This model of training program development, implementation, and evaluation is feasible, evidence-informed, and may be replicated.

Health Care Resources and Mental Health Service Use Among Suicidal Adolescents

Developing policies and interventions that increase rates of mental health service use for suicidal adolescents is crucial for suicide prevention. Data from a sample of suicidal youth (n = 1356) from the National Longitudinal Study of Adolescent Health (Add Health) were analyzed to examine whether type of insurance, receipt of routine medical care, and access to school-based mental health treatment predicted mental health service use cross-sectionally and longitudinally. Rates of mental health service use were low in cross-sectional analyses at all three waves (∼11%–30%), despite the fact that respondents were at high risk for suicide attempts and depression. With demographic factors and symptom severity controlled, only receipt of a routine physical predicted an increased likelihood of mental health service use at wave I and in longitudinal analyses. Implications discussed include the utility of universal suicide screenings and integrated behavioral health care as potential intervention strategies for this population.Developing policies and interventions that increase rates of mental health service use for suicidal adolescents is crucial for suicide prevention. Data from a sample of suicidal youth (n = 1356) from the National Longitudinal Study of Adolescent Health (Add Health) were analyzed to examine whether type of insurance, receipt of routine medical care, and access to school-based mental health treatment predicted mental health service use cross-sectionally and longitudinally. Rates of mental health service use were low in cross-sectional analyses at all three waves (∼11%–30%), despite the fact that respondents were at high risk for suicide attempts and depression. With demographic factors and symptom severity controlled, only receipt of a routine physical predicted an increased likelihood of mental health service use at wave I and in longitudinal analyses. Implications discussed include the utility of universal suicide screenings and integrated behavioral health care as potential intervention strategies for this population.