Factors Associated With Persistent Positive Suicide Screens in the Pediatric Emergency Department

Suicide is a leading cause of death among youth aged 10 to 24. Despite growing attention to suicide prevention, limited research has explored factors linked to persistent positive screens on the Ask Suicide-Screening Questions (ASQ) tool during repeat emergency department (ED) visits. This study aimed to identify sociodemographic and visit-related factors associated with persistent ASQ positivity among pediatric patients.

We conducted a retrospective chart review of pediatric patients (aged 11 to 18) presenting to a tertiary care children's hospital ED between October 2018 and June 2021. Eligible patients had a positive ASQ at the index visit and at least one subsequent ED visit more than 30 days later and before January 2022. Bivariate analyses and multivariable logistic regression were used to identify factors associated with persistent positive ASQ screening at the second visit.

Of 319 encounters, 31% had persistent positive ASQ responses. Females had higher odds of persistent positivity than males (OR = 2.84, 95% CI: 1.50-5.38). Patients transferred to another facility at the index visit had significantly increased odds of persistent ASQ positivity (OR = 7.70, 95% CI: 1.66-35.71), as did those with at least one mental health follow-up visit (OR = 2.30, 95% CI: 1.14-4.67). Private insurance status and provision of inpatient psychiatric resources at the index visit were associated with persistent ASQ positivity in bivariate analysis.

While ASQ screening is effective for identifying suicide risk, persistent positivity suggests current interventions may be insufficient. Efforts to improve continuity of care, reduce systemic barriers, and implement targeted strategies for high-risk youth are warranted.