Suicide Risk Among Youth Who Choose "No Response" on Emergency Department Suicide Risk Screenings.

Area of Science:

• Emergency Medicine
• Adolescent Psychiatry
• Public Health

Background:

• Suicidal behavior is a significant concern in adolescents presenting to emergency departments.
• The Ask Suicide-Screening Questions (ASQ) tool is used in emergency departments (EDs) to identify at-risk youth.
• The implications of adolescents selecting "no response" on ASQ items require further investigation.

Purpose of the Study:

• To compare suicidal behavior outcomes for adolescents who select "no response" on ASQ items versus those who screen negative or positive.
• To evaluate the association between ASQ nonresponse and suicidal ideation, suicide attempts, and mental health service use.

Main Methods:

• Prospective, multisite study (Emergency Department Screen for Teens at Risk for Suicide - ED-STARS) enrolled adolescents in EDs.
• A subset of participants underwent a six-month follow-up, including mental health surveys.
• Participants were categorized into risk groups: positive screen, negative screen, or nonresponse.

Main Results:

• Nonresponse to ASQ items was associated with an intermediate risk for suicidal ideation (OR 2.14) and suicide attempts (OR 2.82).
• Adolescents with ASQ nonresponse showed a higher likelihood of receiving mental health care (OR 3.42).
• Compared to nonresponse, positive ASQ screens indicated higher risks for ideation and attempts.

Conclusions:

• Adolescents who do not respond to suicide screening questions may be at elevated risk for suicidal ideation and behavior.
• Emergency department clinicians should not automatically categorize ASQ nonresponders as negative screens.
• Further attention and appropriate risk assessment are warranted for adolescents with nonresponse on suicide screening tools.