Hospital-Based Pediatric Suicide Risk Screening Outcomes Vary by Demographic and Clinical Characteristics

Suicide is a leading cause of death among youth, yet differences in screening outcomes across demographic groups remain poorly understood. This study examines associations between demographic and clinical characteristics and responses to universal suicide risk and depression screening tools in a pediatric hospital setting.

We conducted a retrospective cohort study of 66,225 patients 10 to 26 years of age who were screened with the Ask Suicide-Screening Questions (ASQ) and Patient Health Questionnaire-9 (PHQ-9) across emergency, urgent care, and inpatient settings. Demographic and clinical data were extracted from electronic health records. Response categories to the ASQ and PHQ-9 were analyzed against these factors with frequency and association tests.

Positive ASQ screens occurred in 8.5% of patients (1.9% acute positive), with elevated rates among older youth and those assigned female at birth. Hispanic/Latino ethnicity and private insurance were associated with lower-than-expected rates of positive screens, whereas having a military insurance payor and higher Area Deprivation Index scores were associated with increased risk. Depression symptoms were more prevalent than suicidal ideation and showed similar demographic patterns.

Demographic and clinical factors are correlated with suicide and depression screening outcomes. These findings highlight opportunities to improve equity in screening practice.