Pediatric Suicide Attempt Non-Disclosure: an Analysis of Discrepant Screening Results

The Ask-Suicide Screening Questions (ASQ) is a validated tool developed to assess suicidal risk in pediatric medical settings with one item assessing historical attempts. While the psychometric properties of the ASQ are well-established, little is known about how youth respond to this question upon repeated administrations. We conducted a retrospective analysis of electronic medical record data by youth who received the ASQ from December 2019 to November 2023 at an urban academic children's hospital. Youth who disclosed a suicide attempt but denied an attempt history at a subsequent visit were identified. Multivariate regression and manual chart review were utilized to identify demographic and clinical variables related to non-disclosure of a previously disclosed attempt. Of 1861 encounters (1460 unique patients) with a disclosed historic suicide attempt, re-screening occurred in 503 future encounters. One hundred forty instances of nondisclosure occurred (127 unique patients). Encounters were classified into false positives (N = 26), encounters where nondisclosure by patients did not impact clinical response (N = 40), and encounters where nondisclosure resulted in no further suicide risk assessment (N = 74). Of this last group, 47.3% received no risk assessment at the initial visit. Compared to the initial visit, the nondisclosure visit was more likely to have a medical presenting complaint and to have negative responses on ASQ questions related to recent suicidal ideation. Denial of a historic attempt upon repeat administration of the ASQ is not uncommon among pediatric patients, and this is more likely to occur at an encounter for a medical presenting complaint.