Child Opportunity Index and Suicide Risk Screening Positivity in Pediatric Emergency and Urgent Care Patients Presenting Without Behavioral Health Complaints

OBJECTIVES: We examined associations between the Child Opportunity Index (COI) and suicide risk screening positivity among pediatric Emergency Department (ED) and Urgent Care (UC) patients without behavioral health complaints. We hypothesized that lower COI was associated with increased suicide screening rate positivity. METHODS: This single-center repeated cross-sectional ecological study included children 10-18 years old who presented to the ED/UC March 2019-December 2021 and screened positive for suicide risk. ZIP codes with >2 positive suicide screens were included in the catchment area. We conducted an ordinary least squares regression to evaluate COI as a predictor of the log-transformed rate of positive suicide screens. Multivariate clustering visualized the spatial and temporal relationship (including pre-/post-COVID-19 pandemic onset) of the COI indicators and positive suicide screen rate. RESULTS: Of 33,504 patients who completed universal screening for suicide, 2690 (8%) were positive and 94% resided within the catchment area. Overall, COI was not statistically associated with positive suicide screen rate (P=0.07). Before the COVID-19 pandemic, lower COI was associated with increased positive suicide risk screening rates (P=0.01); this association was not statistically significant after the COVID-19 pandemic onset. CONCLUSIONS: In this study of pediatric ED and UC patients screened for suicide risk, there was no significant association between COI and suicide risk. However, observed temporal differences during the pandemic period suggest that unmeasured factors may have contributed to geographic variation in pediatric suicide risk, which warrants further investigation.