Why Preteens in the ED Should be Screened for Suicide Risk

Screening revealed that 7% of 10-to-12-year-olds who came to three children’s hospital emergency departments for medical complaints such as headache, back pain or seizures, were at risk for suicide, a recent study found.

More than half of children in the same age group presenting to the emergency department with psychiatric complaints such as depression, violent behavior or panic disorder, screened positive for suicide risk.

“It’s concerning and consistent with other studies indicating that children – preteens – are presenting in emergency departments with suicidal ideation and behavior,” says Jeff Bridge, PhD, an epidemiologist director of the Center for Suicide Prevention and Research at Nationwide Children’s, and senior author of the study.

“The difference is that in this study, we’re uncovering risk,” says Dr. Bridge, who is also a professor of pediatrics, psychiatry, and behavioral health at The Ohio State University College of Medicine. “These are not all kids who come to the emergency department because they are thinking about or have attempted suicide.”

Suicide is the third leading cause of death among preteens age 10 to 12. The researchers suggest screening all children as young as 10 for suicide risk in the emergency room as well as primary care offices and medical and surgical units, where preteens are seen more frequently, could save lives. Their study is published in Hospital Pediatrics.

The study is a subanalysis made from the multistate study used to develop the Ask Suicide-Screening Questions (ASQ) screening tool to assess suicide risk in pediatric patients. That study included 524 pediatric patients, 79 who were ages 10 to 12.

The preteens in the subanalysis were screened using the four-question ASQ and the 15-question Suicide Ideation Questionnaire, which assesses severity of suicide ideation in the past month. The children had come to emergency departments at Boston Children’s Hospital, Children’s National Medical Center in Washington DC and Nationwide Children’s Hospital.

The researchers say, “There is a myth that younger children don’t think about, plan or attempt suicide.” But in this study, 18% reported they had tried to kill themselves and half of them said they had made the attempt at age 10 or younger. All of the children who reported past attempts were in the emergency department for psychiatric complaints.

“But because the 7% of preteens who present in the emergency department with physical complaints are at risk for suicidal behavior, we should be screening kids as young as 10 regardless of presenting complaint or concern,” Dr. Bridge says.

The researchers are in the process of developing screening and intervention protocols to be used in all medical settings. Because 9% reported a suicide attempt at age 10 or younger, the researchers believe further studies into younger children are warranted.

“If we identify youth at risk of suicide earlier in the process, we can help prevent it,” Dr. Bridge says. “The risk of suicide increases greatly if a child, adolescent or adult attempts suicide once. Our goal is to prevent the first attempt from ever occurring.”

Reference:

Lanzillo EC, Horowitz LM, Wharf EA, Sheftall AH, Pao M, Bridge JA. The importance of screening preteens for suicide risk in the emergency department. Hospital Pediatrics. 2019 Apr;9(4):305-307.

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