title: Screening for adolescent suicidality in primary care: the bullying-insomnia-tobacco-stress test. A population-based pilot study.
abstract: Adolescents at risk for suicide often see their general practitioner solely for somatic or administrative reasons. A simple screening test given during a conversation would be of substantial help to send a signal and tackle the problem. We propose to update a screening test previously validated in France - the TSTS-Cafard - because of significant changes in the lives of adolescents with the growth of the cyber world since 2000.
  
  
  
  The design and setting was a cross-sectional study involving 912 15-year-old adolescents in 90 French schools. They completed a questionnaire that included the TSTS-Cafard and risk factors extracted from the Health Behaviour in School-Aged Children survey. To improve the test, we selected questions drawn from the recent literature. Answers were analysed according to 'suicidality' = at least one suicide attempt in life or suicidal ideation often over the past 12 months.
  
  
  
  Suicidality rates were 9.6% for boys and 23.1% for girls. Although the TSTS-Cafard test was generally effective, one question was no longer discriminating. A new test, entitled 'BITS', included only four questions on bullying, insomnia, tobacco and stress, with three levels of response and scores ranging from 0 to 8. Improvement was achieved without loss of performance. Using a cut-off score of 3, we achieved 78% accuracy (area under the curve), 75% sensitivity and 70% specificity.
  
  
  
  The BITS test could allow the question of suicide risk to be addressed during a routine check-up in primary care but the results need to be validated with 13 to 18-year olds.
authors.affiliation: Faculty of Medicine, Department of General Practice, Poitiers, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Binder
authors.affiliation: Faculty of Medicine, Department of General Practice, Poitiers, France.
authors.forename: Anne-Laure
authors.initials: AL
authors.lastname: Heintz
authors.affiliation: Faculty of Medicine, Department of General Practice, Poitiers, France.
authors.forename: Coralie
authors.initials: C
authors.lastname: Servant
authors.affiliation: Rectory Poitiers Health Service, Poitiers, France.
authors.forename: Marie-Thérèse
authors.initials: MT
authors.lastname: Roux
authors.affiliation: Research Analyst Regional Health Observatory (ORS) Poitou-Charentes, Saint-Benoit, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Robin
authors.affiliation: INSERM Q3 U894, Psychiatry and Neurosciences Center, Child and Adolescent Psychiatry Department, University of Poitiers, Poitiers, France.
authors.forename: Ludovic
authors.initials: L
authors.lastname: Gicquel
authors.affiliation: INSERM CIC-1402, Faculty of Medicine, Department of Epidemiology & Biostatistics, Poitiers, Poitiers, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Ingrand
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior / Q000523:psychology*; D058445:Bullying / Q000523:psychology*; D003430:Cross-Sectional Studies; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D010865:Pilot Projects; D011237:Predictive Value of Tests; D011320:Primary Health Care / Q000379:methods* / Q000706:statistics & numerical data; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors; D012680:Sensitivity and Specificity; D007319:Sleep Initiation and Maintenance Disorders / Q000175:diagnosis* / Q000523:psychology; D012907:Smoking / Q000453:epidemiology / Q000523:psychology*; D013315:Stress, Psychological / Q000175:diagnosis* / Q000453:epidemiology; D059020:Suicidal Ideation; D013406:Suicide, Attempted / Q000523:psychology* / Q000706:statistics & numerical data; D062789:Tobacco Products
keywords: adolescent; general practice; mass screening; primary health care; suicide attempt