The feasibility and concurrent validity of adolescent suicide risk screening in medical emergency departments (EDs) has been documented. The objectives of this short-term prospective study of adolescents who screened positive for suicide risk in the ED were: 1) to examine adolescents' rate of suicidal behavior during the 2 months following their ED visits and compare it with reported rates for psychiatric samples; and 2) to identify possible predictors of acute risk for suicidal behavior in this at-risk sample.
Method:
Participants were 81 adolescents, ages 14–19 years, seeking services for psychiatric and nonpsychiatric chief complaints, who screened positive for suicide risk because of recent suicidal ideation, a suicide attempt, and/or depression plus alcohol or substance misuse. A comprehensive assessment of suicidal behavior, using the Columbia-Suicide Severity Rating Scale, was conducted at baseline and 2 month follow-up.
Results:
Six adolescents (7.4%) reported a suicide attempt and 15 (18.5%) engaged in some type of suicidal behavior (actual, aborted, or interrupted suicide attempt; preparatory behavior) during the 2 months following their ED visit. These rates suggest that this screen identified a high-risk sample. Furthermore, adolescents who screened positive for suicidal ideation and/or attempt plus depression and alcohol/substance misuse were most likely to engage in future suicidal behavior (38.9%).
Conclusions:
In this study, use of a higher screen threshold (multiple suicide risk factors) showed promise for identifying highly elevated acute risk for suicidal behavior.
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References
1.
AsarnowJR, BaraffLJ, BerkM, GrobCS, Devich-NavarroM, SuddathR, PiacentiniJC, Rotheram-BorusMJ, CohenD, TangL: An emergency department intervention for linking pediatric suicidal patients to follow-up mental health treatment. Psychiatr Serv, 62:1303–1309, 2011.
2.
AscherBH, FarmerEM, BurnsBJ, AngoldA: The child and adolescent services assessment (CASA): Description and psychometrics. J Emot Behav Disord, 4:12–20, 1996.
BridgeJA, MarcusSC, OlfsonM: Outpatient care of young people after emergency treatment of deliberate self-harm. J Am Acad Child Adolesc Psychiatry, 51:213–222, 2012.
10.
BrittoMT, KlostermannBK, BonnyAE, AltumSA, HornungRW: Impact of a school-based intervention on access to healthcare for underserved youth. J Adolesc Health, 29:116–124, 2001.
Centers for Disease Control and Prevention, National Center for Injury Prevention and Controls: Web-Based Injury Statistics Query and Reporting System (WISQARS). 2014. Available from: www.cdc.gov/ncipc/wisqars. Last accessed January19, 2015.
13.
ChungT, ColbySM, BarnettNP, MontiPM: Alcohol use disorders identification test: Factor structure in an adolescent emergency department sample. Alcohol Clin Exp Res, 26:223–231, 2002.
14.
CzyzEK, BeronaJ, KingCA: A prospective examination of the interpersonal-psychological theory of suicidal behavior among psychiatric adolescent inpatients. Suicide Life Threat Behav, 2014 [Epub ahead of print].
15.
DulcanMK: Treatment for adolescents with depression study (TADS): Rationale, design, and methods. J Am Acad Child Adolesc Psychiatry, 42:531–542, 2003.
16.
FeinJA, PaillerEP, BargFK, Wintersteen MBHK., TienA, DiamondGS: Feasibility and effects of a web-based adolescent psychiatric assessment administered by clinical staff in the pediatric emergency department. Arch Pediatr Adolesc Med, 164:1112–1117, 2010.
17.
GipsonPY, AgarwalaP, OppermanKJ, HorwitzAG, KingCA: Columbia-suicide severity rating scale (C-SSRS): Predictive validity with adolescent psychiatric emergency patients. Pediatr Emerg Care, 2014 [Epub ahead of print].
18.
GoldstonDB, DanielSS, ReboussinBA, ReboussinDM, FrazierPH, HarrisAE: Cognitive risk factors and suicide attempts among formerly hospitalized adolescents: A prospective naturalistic study. J Am Acad Child Adolesc Psychiatry, 40:91–99, 2001.
19.
GouldMS, GreenbergT, VeltingDM, ShafferD: Youth suicide risk and preventive interventions: A review of the past 10 years. J Am Acad Child Adolesc Psychiatry, 42:386–405, 2003.
20.
Grupp–PhelanJ, HarmanJS, KelleherKJ: Trends in mental health and chronic condition visits by children presenting for care at U.S. emergency departments. Public Health Rep, 122:55–61, 2007a.
21.
Grupp–PhelanJ, WadeTJ, PickupT, HoML, LucasCP, BrewerDE, KelleherKJ: Mental health problems in children and caregivers in the emergency department setting. J Dev Behav Pediatr, 28:16–21, 2007b.
22.
HorowitzLM, BridgeJA, TeachSJ, BallardE, KlimaJ, RosensteinDL, WharffEA, GinnisK, CannonE, JoshiP, PaoM: Ask suicide-screening questions (ASQ): A brief instrument for the pediatric emergency department. Arch Pediatr Adolesc Med, 166:1170–1176, 2012.
23.
HorwitzAG, CzyzEK, KingCA: Predicting future suicide attempts among adolescent and emerging adult psychiatric emergency patients. J Clin Child Adolesc Psychol, 2014 [Epub ahead of print].
24.
KannL, KinchenS, ShanklinSL, FlintKH, KawkinsJ, HarrisWA, LowryR, OlsenEO, McManusT, ChyenD, WhittleL, TaylorE, DemissieZ, BrenerN, ThorntonJ, MooreJ, ZazaS, Centers for Disease Control and Prevention: Youth risk behavior surveillance – United States, 2013. MMWR Surveill Summ, 63Suppl 4:1–168, 2014.
25.
KingCA, FosterCE, RogalskiKM: Teen Suicide Risk: A Practitioner Guide to Screening, Assessment, and Management. New York: Guilford Press; 2013
26.
KingCA, GipsonPY, HorwitzAG, OppermanKJ: Teen options for change (TOC): An intervention for adolescent emergency patients who screen positive for suicide risk. Psychiatr Serv, 2014a [Epub ahead of print].
27.
KingCA, HoveyJD, BrandE, GhaziuddinN: Prediction of positive outcomes for adolescent psychiatric inpatients. J Am Acad Child Adolesc Psychiatry, 36:1434–1442, 1997.
28.
KingCA, JiangQ, CzyzEK, KerrDCR: Suicidal ideation of psychiatrically hospitalized adolescents has one-year predictive validity for suicide attempts in girls only. J Abnorm Child Psychol, 42:467–477, 2014b.
29.
KingCA, KlausN, KramerA, VenkataramanS, QuinlanP, GillespieB: The youth-nominated support team–version ii for suicidal adolescents: A randomized controlled intervention trial. J Consult Clin Psychol, 77:880–893, 2009a.
30.
KingCA, KramerA: Intervention research with youths at elevated risk for suicide: Meeting the ethical and regulatory challenges of informed consent and assent. Suicide Life Threat Behav, 38:486–497, 2008.
31.
KingCA, O'MaraRM, HaywardCN, CunninghamRM: Adolescent suicide risk screening in the emergency department. Acad Emerg Med, 16:1234–1241, 2009b.
32.
KnightJR, SherrittL, ShrierLA, HarrisSK, ChangG: Validity of the crafft substance abuse screening test among adolescent clinic patients. Arch Pediatr Adolesc Med, 156:607–614, 2002.
33.
LewinsohnPM, RohdeP, SeeleyJR, BaldwinCL: Gender differences in suicide attempts from adolescence to young adulthood. J Am Acad Child Adolesc Psychiatry, 40:427–434, 2001.
34.
MarttunenMJ, AroHM, LonnqvistJK: Adolescent suicide: Endpoint of long-term difficulties. J Am Acad Child Adolesc Psychiatry, 31:649–654, 1992.
35.
MilfontTL, MerryS, RobinsonE, DennyS, CrengleS, AmeratungaS: Evaluating the short form of the reynolds adolescent depression scale in New Zealand adolescents. Aust N Z J Psychiatry, 42:950–954, 2008.
36.
NockMK, GreenJG, HwangI, McLaughlinKA, SampsonNA, ZaslavskyAM, KesslerRC: Prevalence, correlates, and treatment of lifetime suicidal behavior among adolescents: Results from the national comorbidity survey replication adolescent supplement. JAMA Psychiatry, 70:300–310, 2013.
37.
O'MaraRM, HillRM, CunninghamRM, KingCA: Adolescent and parent attitudes toward screening for suicide risk and mental health problems in the pediatric emergency department. Pediatr Emerg Care, 28:626–632, 2012.
38.
OlfsonM, GameroffMJ, MarcusSC, GreenbergT, ShafferD: Emergency treatment of young people following deliberate self-harm. Arch Gen Psychiatry, 62:1122–1128, 2005.
39.
OlfsonM, MarcusSC, BridgeJA: Emergency treatment of deliberate self-harm. Arch Gen Psychiatry, 69:80–88, 2012.
40.
PosnerK, BrownGK, StanleyB, BrentDA, YershovaKV, OquendoMA, CurrierGW, MelvinGA, GreenhillL, ShenS: The Columbia–Suicide Severity Rating Scale: Initial validity and internal consistency findings from three multisite studies with adolescents and adults. Am J Psychiatry, 168:1266–1277, 2011.
41.
QinP, NordentoftM: Suicide risk in relation to psychiatric hospitalization. Arch Gen Psychiatry, 62:427–432, 2005.
42.
RaoU, WeissmanMM, MartinJA, HammondRW: Childhood depression and risk of suicide: A preliminary report of a longitudinal study. J Am Acad Child Adolesc Psychiatry, 32:21–27, 1993.
43.
ReinertDF, AllenJP: The alcohol use disorders identification test: An update of research findings. Alcoholism Clin Exp Res, 31:185–199, 2007.
44.
ReynoldsWM: Reynolds Adolescent Depression Scale, 2nd Edition: Short Form (RADS-2:SF). Lutz, FL: Psychological Assessment Resources, Inc.; 2008.
SaundersJB, AaslandOG, BaborTF, de la FuenteJR, GrantM: Development of the alcohol use disorders identification test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption—II. Addiction, 88:791–804, 1993.
47.
ShafferD, GouldMS, FisherPW, TrautmanP, MoreauD, KleinmanM, FloryM: Psychiatric diagnosis in child and adolescent suicide. Arch Gen Psychiatry, 53:339–348, 1996.
48.
SPSS Inc.: SPSS for Windows. Chicago: SPSS Inc; 2012.
49.
TingSA, SullivanAF, BoudreauxED, MillerI, CamargoCAJr: Trends in US emergency department visits for attempted suicide and self-inflicted injury, 1993–2008. Gen Hosp Psychiatry, 34:557–565, 2012.
50.
VitielloB, SilvaS, RohdeP, KratochvilC, KennardB, ReineckeM, MayesT, PosnerK, MayDE, MarchJS: Suicidal events in the treatment for adolescents with depression study (TADS). J Clin Psychiatry, 70:741–747, 2009.
