Universal Suicide Risk Screening in Schools: Outcomes from 9 Years of Implementation

Abstract Schools are critical environments for addressing youth suicide. Universal screening for depression and suicide risk is a valuable upstream suicide prevention approach that can be used in schools when combined with evidence-based programming. From Fall 2015 through Spring 2024, the Center for Suicide Prevention and Research (CSPR) at Nationwide Children’s Hospital (NCH) implemented the Signs of Suicide (SOS) prevention program with enhanced universal suicide screening in schools across 26 Ohio counties. Data examined include screening outcomes, staff perceptions of programming, and school-level demographics. The aims of this paper are to describe enhanced universal screening processes developed using a continuous quality improvement approach, to report on perceptions of school personnel regarding the effectiveness, acceptability, and feasibility of universal screening, to examine screening outcomes from 9 years of school-based suicide prevention efforts, and to evaluate associations between relevant school characteristics and screening outcomes to inform best practices. We fit a Poisson regression model on survey data using generalized estimating equations to estimate incident rate ratios of screening outcomes by school characteristics. School personnel perceived depression and suicide screening processes to be effective, acceptable, and feasible. Of the 78,514 students screened, 20,352 required follow-up due to elevated depressive symptoms or endorsement of suicidal thoughts or behaviors, and 4402 received mental health referrals. Differences in screening outcomes are reported across school characteristics. Implications for screening preparation, implementation, and follow-up are discussed.