Emergency Department Screen for Teens at Risk of Suicide

Importance of Emergency Departments in Reaching Youth At-Risk for Suicide

Approximately 1/3 of all adolescents visit emergency departments each year. Annual visits for suicide attempts and nonsuicidal self-injury more than doubled from 1993-1996 and 2005-2008, especially for 15-19 year olds.

In a related study, a high proportion of adolescents with non-psychiatric complaints who screened positive for suicide risk were not receiving any mental health services.

Emergency department visits offer an opportunity to identify, treat, and refer at-risk adolescents, but there are few evidence-based youth screens or interventions. The Whiteriver Indian Health Service Hospital is participating as a site because the prevalence rate for suicide deaths is substantially higher among Indigenous youth than among any other racial and ethnic subgroup of youth in the United States.

Lessons about Suicide Screening

Emergency Department Screen for Teens at Risk of Suicide (ED-STARS) will provide clinicians with new information on how to systematically and efficiently screen adolescent patients in the emergency department for suicide risk.

Phase 1

  • Develop and administer a computerized adaptive screen (i.e., personalized) using a broad range of risk factors (or warning signs) with approximately 6,750 youth (ages 12-17) who present to participating emergency departments.
  • Follow-up 30% of these youth who screen positive for several critical suicide risk factors at 3 and 6 months by phone or in-person.
  • Obtain their permission to access medical chart data.
  • Improve the screening process to more accurately predict future risk for suicide attempts.

Phase 2

  • Survey a new group of approximately 2,400 youths who present to participating emergency departments with different levels of suicide risk with a computerized adaptive measure and a few other surveys.
  • Follow-up all participants with phone or in-person interviews and medical chart reviews at 3 months.
  • Evaluate the ability of the newly developed screen and a behavioral measure— an innovative approach to try to measure our implicit associations to predict suicide attempts.
  • Recognize that suicidal individuals might not feel comfortable revealing all of their thoughts and feelings on a self-report survey and the behavioral test may allow us to better understand their risk.
    Implications for youth

This opportunity will build on current efforts by the Whiteriver research team, Johns Hopkins partners and the Indian Health Service to prevent youth suicide because:

  • Screening in the ED can identify at-risk Apache youth and link them to services.
  • This research can help other tribes facing similar risk factors for youth suicide.
  • Participating in a national multi-site study and working with non-American Indian sites to address suicide may attract other resources and public awareness to tribal needs.

This project is supported by the National Institute of Mental Health.