Evaluating Equity in Universal Suicide Screening: Race/Ethnic Differences in Screening Acceptance and Results

Youth suicide is a critical public health issue. Universal screening in healthcare settings can provide clinical pathways for early identification of suicide risk by assessing suicidal thoughts and behaviors and connection to care. This study aimed to examine whether participation in universal suicide risk screening varies by demographic factors, including race/ethnicity, given documented disparities in suicide rates across racial/ethnic groups.

Patient responses on the Ask Suicide-Screening Questions, demographics, and service use factor data were drawn from patient medical records for ambulatory and acute care visits within a large children's hospital system between June 1, 2021, and September 12, 2023, for patients aged ≥10 years who presented for in-person visits in an eligible clinic and were asked to complete a suicide risk screening.

A total of 160,228 visits for patients aged between 10 and 25 (mean age=14.35) years were included in final analyses. Screening was accepted in 76.95% of visits, and of those screens, 15.87% were positive. After controlling for within-patient correlations, race/ethnicity, sex, and age were significant predictors of screening acceptance and result. White and Latine youth were more likely to accept screening, whereas youth of other races/ethnicities, including Asian and Black youth, were less likely to accept screening. White and multiracial youth were more likely to screen positive, whereas Latine, Asian, and Pacific Islander youth were less likely to screen positive.

Racial/ethnic differences in screening acceptance and results indicate disparities in suicide risk identification among youth. More work is needed to understand the factors impacting engagement in screening and to ensure equitable suicide risk identification.