Suicide screening in schools, primary care and emergency departments.
OBJECTIVE
Every year, suicide claims the lives of tens of thousands of young people worldwide. Despite its high prevalence and known risk factors, suicidality is often undetected. Early identification of suicide risk may be an important method of mitigating this public health crisis. Screening youth for suicide may be a critical step in suicide prevention. This paper reviews suicide screening in three different settings: schools, primary care clinics and emergency departments (EDs).


RESULTS
Unrecognized and thus untreated suicidality leads to substantial morbidity and mortality. With the onus of detection falling on nonmental health professionals, brief screening tools can be used to initiate more in-depth evaluations. Nonetheless, there are serious complexities and implications of screening all children and adolescents for suicide. Recent studies show that managing positive screens is a monumental challenge, including the problem of false positives and the burden subsequently posed on systems of care. Furthermore, nearly 60% of youth in need of mental health services do not receive the care they need, even after suicide attempt. Schools, primary care clinics and EDs are logical settings where screening that leads to intervention can be initiated.


CONCLUSIONS
Valid, brief and easy-to-administer screening tools can be utilized to detect risk of suicide in children and adolescents. Targeted suicide screening in schools, and universal suicide screening in primary care clinics and EDs may be the most effective way to recognize and prevent self-harm. These settings must be equipped to manage youth who screen positive with effective and timely interventions. Most importantly, the impact of suicide screening in various settings needs to be further assessed.
Horowitz
Lisa M
LM
National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892-1276, USA. horowitzl@mail.nih.gov
Ballard
Elizabeth D
ED
Pao
Maryland
M
D000293:Adolescent; D002648:Child; D003866:Depressive Disorder / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D004636:Emergency Service, Hospital; D006801:Humans; D008403:Mass Screening / Q000379:methods*; D011320:Primary Health Care; D018570:Risk Assessment; D012572:School Health Services; D013405:Suicide / Q000523:psychology*; D000092864:Suicide Prevention