Suicide Risk Screening in a Children's Hospital: Association of Positive Screens With Presenting Complaints

Suicide is a leading cause of death among young people aged 10-24 years. Better methods of identifying, preventing, and treating suicidal thoughts or behaviors are needed. We seek to identify associations between positive suicide risk screening and presenting complaint.

We completed a retrospective, electronic health record review of children who were screened for suicide risk using the Ask Suicide-Screening Questions (ASQ) between January 1, 2020 and December 31, 2023 at a large, urban, tertiary care children's hospital. The primary study outcome was a positive screen on the ASQ.

Of 23,154 ASQ screenings completed, 15.2% of the 16,622 visits in the emergency department (ED) included a positive screen and 13.1% of the 6,532 visits in the inpatient setting included a positive screen. Of patients presenting with a medical complaint (n = 13,831), 5.2% of ED visits included a positive screen and 9.1% of inpatient setting visits included a positive screen. Acute positive screens were less common in the ED (0.8%) than in medical inpatient units (2.4%). Youth presenting with unintentional poisoning were significantly more likely to screen positive for suicide risk in the ED (odds ratio: 33.44) and medical inpatient units (odds ratio: 127.31) when compared to the reference category.

High rates of positive suicide risk screens exist in patients presenting with medical chief complaints, especially those presenting with unintentional poisoning or somatic complaints. These findings support the potential for universal suicide risk screening to identify youth at high risk for suicidality that may otherwise be missed.