title: Identification of suicide risk among rural youth: implications for the use of HEADSS.
abstract: BACKGROUND
  Nurse practitioners have the power to assess psychosocial risk and detect and prevent suicide, a problem plaguing rural areas of the United States. Suicide risk assessment can be completed using the Home, Education, Activities, Drug use and abuse, Sexual behavior, and Suicidality and depression (HEADSS) interview instrument. The purpose of this study was to determine if HEADSS is appropriate for guiding suicide risk assessment of rural adolescents.
  
  
  METHODS
  High school students in Southwestern Pennsylvania completed qualitative questions from the Child Behavior Checklist and Coping Response Inventory as part of the Intervention to Promote Mental Health in Rural Youth. Qualitative content analysis was performed.
  
  
  RESULTS
  Prominent themes identified by participants included academic performance, relationships, dislikes about school, friends, death, mental health, and the future. Several minor themes concerned safety. Most known risk factors for suicide were concerns of participants.
  
  
  CONCLUSIONS
  The expansion of HEADSS to include death and safety should be considered. The modified version-HEADDSSS-can be used to guide suicide risk assessment of youth in rural Pennsylvania, ensuring both thoroughness of assessment and safety.
authors.affiliation: gingerbiddle@comcast.net <gingerbiddle@comcast.net>
authors.forename: Virginia Sue
authors.initials: VS
authors.lastname: Biddle
authors.forename: L Kathleen
authors.initials: LK
authors.lastname: Sekula
authors.forename: Rick
authors.initials: R
authors.lastname: Zoucha
authors.forename: Kathryn R
authors.initials: KR
authors.lastname: Puskar
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D000367:Age Factors; D003863:Depression / Q000175:diagnosis* / Q000209:etiology / Q000451:nursing; D055317:Evidence-Based Practice; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D007407:Interviews as Topic / Q000379:methods; D008297:Male; D008603:Mental Health; D009722:Nurse Practitioners; D010414:Pennsylvania / Q000453:epidemiology; D018570:Risk Assessment; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data*; D012574:Schools; D012725:Sexual Behavior; D013334:Students; D013405:Suicide / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D055815:Young Adult; D000092864:Suicide Prevention