Comprehensive Suicide Risk Screening: Depression Is Not Enough

Introduction: In response to increasing suicide rates among youth, further focus has been put on screening for suicide and associated risk factors across health care settings. A frequent approach has been to rely on depression as the only risk factor part of the screening process. Adolescents admitted to inpatient pediatrics have an inherently higher risk for suicide given their medical comorbidities, and available literature has shown that focusing only on depression symptoms is inadequate. Methods: The following validated psychiatric screening tools were used: Generalized Anxiety Disorder 2-item, Patient Health Questionnaire-2, Screening to Brief Intervention, and Ask Suicide-Screening Questions. An aggregate, self-scoring tool was created for the electronic health record with an automatic best practice advisory for positive screens. All 1260 patients admitted to inpatient pediatrics, aged 12 to 17 years, were screened. The screening results and completion rates were tracked over 2 years. Results: The screening completion rate was 90% (n = 1134). Forty-one percent of the positive screens had only symptoms of anxiety and/or a risk for severe substance use disorder. Of the positive screens, anxiety was the sole symptom category for 23%, risk for severe substance use disorder for 18%, and just 7% for depression. No patients screened positive for “acute” suicidal ideation. Discussion: Almost half of the screens considered positive did not score positive for depression, strongly supporting this more comprehensive approach in identifying patients with greater risk for suicide. Feasibility was achieved with a 90% completion rate over the 2-year pilot period of this quality initiative. Conclusions: Effectively screening for suicide risk in youth should not rely on targeting depression symptoms and asking directly about suicidal ideation.