title: Evaluating iatrogenic risk of youth suicide screening programs: a randomized controlled trial.
abstract: BACKGROUND
  Universal screening for mental health problems and suicide risk is at the forefront of the national agenda for youth suicide prevention, yet no study has directly addressed the potential harm of suicide screening.
  
  
  OBJECTIVE
  To examine whether asking about suicidal ideation or behavior during a screening program creates distress or increases suicidal ideation among high school students generally or among high-risk students reporting depressive symptoms, substance use problems, or suicide attempts.
  
  
  METHODS
  A randomized controlled study conducted within the context of a 2-day screening strategy. Participants were 2342 students in 6 high schools in New York State in 2002-2004. Classes were randomized to an experimental group (n = 1172), which received the first survey with suicide questions, or to a control group (n = 1170), which did not receive suicide questions.
  
  
  METHODS
  Distress measured at the end of the first survey and at the beginning of the second survey 2 days after the first measured on the Profile of Mood States adolescent version (POMS-A) instrument. Suicidal ideation assessed in the second survey.
  
  
  RESULTS
  Experimental and control groups did not differ on distress levels immediately after the first survey (mean [SD] POMS-A score, 5.5 [9.7] in the experimental group and 5.1 [10.0] in the control group; P = .66) or 2 days later (mean [SD] POMS-A score, 4.3 [9.0] in the experimental group and 3.9 [9.4] in the control group; P = .41), nor did rates of depressive feelings differ (13.3% and 11.0%, respectively; P = .19). Students exposed to suicide questions were no more likely to report suicidal ideation after the survey than unexposed students (4.7% and 3.9%, respectively; P = .49). High-risk students (defined as those with depression symptoms, substance use problems, or any previous suicide attempt) in the experimental group were neither more suicidal nor distressed than high-risk youth in the control group; on the contrary, depressed students and previous suicide attempters in the experimental group appeared less distressed (P = .01) and suicidal (P = .02), respectively, than high-risk control students.
  
  
  CONCLUSIONS
  No evidence of iatrogenic effects of suicide screening emerged. Screening in high schools is a safe component of youth suicide prevention efforts.
authors.affiliation: Division of Child and Adolescent Psychiatry, Columbia University and New York State Psychiatric Institute, New York, NY 10032, USA. gouldm@childpsych.columbia.edu
authors.forename: Madelyn S
authors.initials: MS
authors.lastname: Gould
authors.forename: Frank A
authors.initials: FA
authors.lastname: Marrocco
authors.forename: Marjorie
authors.initials: M
authors.lastname: Kleinman
authors.forename: John Graham
authors.initials: JG
authors.lastname: Thomas
authors.forename: Katherine
authors.initials: K
authors.lastname: Mostkoff
authors.forename: Jean
authors.initials: J
authors.lastname: Cote
authors.forename: Mark
authors.initials: M
authors.lastname: Davies
mesh_terms: D000293:Adolescent; D000339:Affect; D006801:Humans; D008403:Mass Screening; D011569:Psychiatric Status Rating Scales; D012306:Risk; D012574:Schools; D011795:Surveys and Questionnaires; D000092864:Suicide Prevention