title: Bullying and Suicide Risk Among Pediatric Emergency Department Patients.
abstract: OBJECTIVE
  This study aimed to describe the association between recent bullying victimization and risk of suicide among pediatric emergency department (ED) patients.
  
  
  METHODS
  Patients presenting to 1 of 3 different urban pediatric EDs with either medical/surgical or psychiatric chief complaints completed structured interviews as part of a study to develop a suicide risk screening instrument, the Ask Suicide-Screening Questions. Seventeen candidate items and the criterion reference Suicidal Ideation Questionnaire were administered to patients ages 10 to 21 years. Bullying victimization was assessed by a single candidate item ("In the past few weeks, have you been bullied or picked on so much that you felt like you couldn't stand it anymore?").
  
  
  RESULTS
  A total of 524 patients completed the interview (34.4% psychiatric chief complaints; 56.9% female; 50.4% white, non-Hispanic; mean [SD] age, 15.2 [2.6] years). Sixty patients (11.5%) reported recent bullying victimization, and of these, 33 (55.0%) screened positive for suicide risk on the Ask Suicide-Screening Questions or the previously validated Suicidal Ideation Questionnaire. After controlling for demographic and clinical variables, including a history of depression and drug use, the odds of screening positive for suicide risk were significantly greater in patients who reported recent bullying victimization (adjusted odds ratio, 3.19; 95% confidence interval, 1.66-6.11). After stratification by chief complaint, this association persisted for medical/surgical patients but not for psychiatric patients.
  
  
  CONCLUSIONS
  Recent bullying victimization was associated with increased odds of screening positive for elevated suicide risk among pediatric ED patients presenting with medical/surgical complaints. Understanding this important correlate of suicide risk in pediatric ED patients may help inform ED-based suicide prevention interventions.
authors.affiliation: From the *Office of the Clinical Director, National Institute of Mental Health, Bethesda, MD; †Center for Innovation in Pediatric Practice, The Research Institute at Nationwide Children's Hospital; and ‡Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH; §Emergency Psychiatry Service, Boston Children's Hospital; and ∥Department of Psychiatry, Harvard Medical School, Boston, MA; ¶Division of Emergency Medicine, Children's National Health System, Washington, DC.
authors.forename: Ian H
authors.initials: IH
authors.lastname: Stanley
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Horowitz
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Bridge
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Wharff
authors.forename: Maryland
authors.initials: M
authors.lastname: Pao
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Teach
mesh_terms: D000293:Adolescent; D058445:Bullying; D002648:Child; D019548:Crime Victims / Q000523:psychology*; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital; D005260:Female; D006786:Hospitals, Urban; D006801:Humans; D008297:Male; D008403:Mass Screening; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D059020:Suicidal Ideation; D011795:Surveys and Questionnaires; D055815:Young Adult