Identifying adolescents at highly elevated risk for suicidal behavior in the emergency department.
OBJECTIVE
The feasibility and concurrent validity of adolescent suicide risk screening in medical emergency departments (EDs) has been documented. The objectives of this short-term prospective study of adolescents who screened positive for suicide risk in the ED were: 1) to examine adolescents' rate of suicidal behavior during the 2 months following their ED visits and compare it with reported rates for psychiatric samples; and 2) to identify possible predictors of acute risk for suicidal behavior in this at-risk sample.


METHODS
Participants were 81 adolescents, ages 14-19 years, seeking services for psychiatric and nonpsychiatric chief complaints, who screened positive for suicide risk because of recent suicidal ideation, a suicide attempt, and/or depression plus alcohol or substance misuse. A comprehensive assessment of suicidal behavior, using the Columbia-Suicide Severity Rating Scale, was conducted at baseline and 2 month follow-up.


RESULTS
Six adolescents (7.4%) reported a suicide attempt and 15 (18.5%) engaged in some type of suicidal behavior (actual, aborted, or interrupted suicide attempt; preparatory behavior) during the 2 months following their ED visit. These rates suggest that this screen identified a high-risk sample. Furthermore, adolescents who screened positive for suicidal ideation and/or attempt plus depression and alcohol/substance misuse were most likely to engage in future suicidal behavior (38.9%).


CONCLUSIONS
In this study, use of a higher screen threshold (multiple suicide risk factors) showed promise for identifying highly elevated acute risk for suicidal behavior.
1 Department of Psychiatry, University of Michigan Depression Center , Ann Arbor, Michigan.
Cheryl A
CA
King
Johnny
J
Berona
Ewa
E
Czyz
Adam G
AG
Horwitz
Polly Y
PY
Gipson
D000293:Adolescent; D000294:Adolescent Behavior / Q000523:psychology*; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors; D016728:Self-Injurious Behavior / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D059020:Suicidal Ideation; D013406:Suicide, Attempted / Q000517:prevention & control* / Q000523:psychology*; D055815:Young Adult