Youth suicide risk screening in an outpatient child abuse clinic.
Margaret Ngai, Kathleen Delaney, Barbara Limandri and 3 others
PMID 34114309WHAT IT FOUND
Switching from a depression screen to the Ask Suicide-Screening Questions tool in a child abuse clinic more than doubled the detection of youth at risk for suicide.
The new tool also identified significant risk in 10-12 year olds who were previously not screened.
Key findings
01Universal screening with the ASQ tool identified positive suicide risk in 29.2% of screened patients, compared to an 11.3% positive rate with the previous PHQ-9 depression screen.
02The ASQ tool identified suicide risk in children aged 10-12, a group that was not screened under the previous protocol, accounting for nearly a quarter of all positive screens in the study period.
03Staff compliance with the new screening workflow was high, with 90.7% of eligible patients screened during the four-month implementation period.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This was a quality improvement project, not a randomized controlled trial, so improvements in detection could be influenced by other changes occurring at the clinic during the same period. The study did not track long-term outcomes, such as whether the identified youth actually received follow-up care or whether suicide attempts were prevented. Demographic data such as race and gender were not collected due to privacy constraints, so it is unknown if the screening tool performed differently across these groups. The baseline comparison group was small (53 charts) and drawn from a different time period than the intervention group.
Declared interests
The authors declare no conflicts of interest. The study was supported by the NIH Intramural Research Program.
The easy way to misread this
Do not assume that screening positive on the ASQ equates to a suicide attempt or death. The study measured detection rates, not clinical outcomes, and it did not verify if the increased detection led to effective prevention of harm.