Variation in Suicide Risk Screening by Pediatricians Across Subspecialties

OBJECTIVE: This study describes general and subspecialty pediatricians' standardized suicide risk screening practices, variation in screening across subspecialties, and whether knowledge of the American Academy of Pediatrics (AAP) recommendations is associated with standardized suicide risk screening. METHODS: We analyzed survey data from the 2023 American Board of Pediatrics Maintenance of Certification program. Survey items assessed use of standardized suicide risk screening tools, specific tools employed, adoption of universal screening approaches, and knowledge of AAP recommendations. Adjusted logistic regression examined associations between clinician characteristics and screening practices, and between knowledge of recommendations and screening. RESULTS: Overall, 49.1% (5195) of eligible pediatricians responded, with 5003 included in the analysis. Standardized suicide risk screening was reported by 36.7% (1836), with emergency medicine physicians significantly more likely to report using standardized tools than general pediatricians (adjusted odds ratio [AOR] = 2.83; 95% CI: 2.13-3.77). Compared with pediatricians who reported that they were not at all knowledgeable of AAP recommendations, those who reported that they were moderately or very knowledgeable were significantly more likely to report standardized suicide risk screening (AOR = 1.53, 95% CI: 1.29-1.83). Among pediatricians who reported screening, 73.1% (1249) used a universal screening approach for children aged 12 years and older, with significant variation across subspecialties in the tools used. CONCLUSIONS: Approximately 1 in 3 pediatricians reported using standardized suicide risk screening, with significant variability across subspecialties. Knowledge of AAP recommendations was associated with screening, suggesting that widespread dissemination of practice guidelines may increase implementation, particularly in subspecialty practices where early identification and timely interventions are less common.