Lowering the Age Limit in Suicide Risk Screening: Clinical Differences and Screening Form Predictive Ability

Our research provides preliminary evidence that suicide risk screening is warranted in patients as young as 8-9 years old presenting to the emergency department (ED) with behavioral and mental health symptoms. The goal of this retrospective cohort study (N = 2,466 unique patient visits) was to assess the value of suicide risk screening in children younger than 10 years old who present to the ED with behavioral and mental health concerns. The Johns Hopkins Hospital pediatric ED began screening with the Ask Suicide-Screening Questions (ASQ) for patients 8-21 years old who presented with a behavioral or mental health concern in March 2013 as ED standard of care. We examined the demographic and clinical differences between younger (8-9 years old; n = 270) and older (10-21 years old; n = 2,196) youths who were screened for suicide risk with the ASQ (from March 13, 2013 through December 31, 2016). In summary, 36% of 8- and 9-year-old patients who came to the ED for behavioral and mental health concerns screened positive for suicide risk on the ASQ. The younger patients who screened positive were more likely to present with externalizing symptoms and hallucinations and less likely to present with suicidal ideation or an attempt than their older counterparts. Importantly, 71.1% of 8- to 9-year-old patients who screened positive did not present to the ED for suicidal ideation or attempt vs 50.1% (614/1,226) of patients older than age 10 years.