Integrating Brief Screen in ER May Better Identify Youth With Psychosis at Risk of Suicide

Almost half (48%) of children and adolescents with a psychotic disorder said they recently had suicidal thoughts or had in the past considered death by suicide when interviewed in the emergency department (ED) using a brief screening questionnaire, according to a report published this week in Psychiatric Services. Most of these youth did not report a chief complaint related to suicidal ideation or behavior when arriving at the ED.

Notably, half of the children and adolescents who screened positive for suicide using the Ask Suicide-Screening Questions (ASQ) screen were discharged from the ED, including 44% of those who reported having suicidal thoughts within the past few weeks.

“ASQ screening is imperative for the identification of youths at risk for suicide, but it needs to be paired with feasible follow-up intervention services,” wrote Jonathan DeVylder, Ph.D., of Fordham University and colleagues.

DeVylder and colleagues analyzed data on 87 children and adolescents aged 8 to 18 with a psychotic disorder who were screened for suicide risk in the ED using the ASQ at the Johns Hopkins Hospital pediatric ED. Youth were included if they had schizophrenia, schizoaffective disorder, major depressive disorder with psychotic features, or bipolar disorder with psychotic features, as recorded in the electronic health record.

The ASQ includes the following four yes/no questions: (1) In the past few weeks, have you wished you were dead?; (2) In the past few weeks, have you felt that you or your family would be better off if you were dead?; (3) In the past week, have you been having thoughts about killing yourself?; and (4) Have you ever tried to kill yourself? A positive response to any item is considered a positive screen.

The ASQ missed one young person with a suicide-related chief complaint. However, the authors noted that treatment as usual on the basis of chief complaints missed 26 young people that ASQ identified as at risk. The ASQ therefore increased detection of suicide risk almost threefold (2.63 times) relative to the chief complaint alone.

DeVylder and colleagues noted that the risk of suicide is especially pronounced shortly after the onset of psychosis, which tends to occur in adolescence or early adulthood. “This factor further compounds the elevated risk of suicide among adolescents after they are discharged from hospital-based psychiatric care,” they wrote.

For related information, see the Psychiatric News article “Surge in Suicide Prompts Call For Diagnostic Category.”

(Image: iStock/MJFelt)

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