School-based screening for suicide risk: balancing costs and benefits.
OBJECTIVE
We examined the effects of a scoring algorithm change on the burden and sensitivity of a screen for adolescent suicide risk.


METHODS
The Columbia Suicide Screen was used to screen 641 high school students for high suicide risk (recent ideation or lifetime attempt and depression, or anxiety, or substance use), determined by subsequent blind assessment with the Diagnostic Interview Schedule for Children. We compared the accuracy of different screen algorithms in identifying high-risk cases.


RESULTS
A screen algorithm comprising recent ideation or lifetime attempt or depression, anxiety, or substance-use problems set at moderate-severity level classed 35% of students as positive and identified 96% of high-risk students. Increasing the algorithm's threshold reduced the proportion identified to 24% and identified 92% of high-risk cases. Asking only about recent suicidal ideation or lifetime suicide attempt identified 17% of the students and 89% of high-risk cases. The proportion of nonsuicidal diagnosis-bearing students found with the 3 algorithms was 62%, 34%, and 12%, respectively.


CONCLUSIONS
The Columbia Suicide Screen threshold can be altered to reduce the screen-positive population, saving costs and time while identifying almost all students at high risk for suicide.
Scott
Michelle
M
Department of Child Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA. mscott@monmouth.edu
Wilcox
Holly
H
Huo
Yanling
Y
Turner
J Blake
JB
Fisher
Prudence
P
Shaffer
David
D
D000293:Adolescent; D000294:Adolescent Behavior; D000465:Algorithms; D001007:Anxiety / Q000175:diagnosis* / Q000473:pathology; D003863:Depression / Q000175:diagnosis* / Q000523:psychology; D005260:Female; D006801:Humans; D007406:Interview, Psychological; D008297:Male; D008403:Mass Screening / Q000458:organization & administration*; D009519:New York City; D011237:Predictive Value of Tests; D000297:Psychology, Adolescent; D011594:Psychometrics; D012307:Risk Factors; D012572:School Health Services / Q000458:organization & administration*; D012680:Sensitivity and Specificity; D019966:Substance-Related Disorders / Q000175:diagnosis* / Q000523:psychology; D013405:Suicide / Q000523:psychology; D011795:Surveys and Questionnaires; D000092864:Suicide Prevention