Feasibility and Acceptability of Suicide Screening in the Pediatric Emergency Department

Introduction: Screening for suicide risk in pediatric emergency departments (EDs) is a promising method of early identification.  Patients in the pediatric ED may be at increased risk for suicide due to individual risk factors including depression, trauma, pain and substance abuse.  Additionally, the ED may be an ideal setting for screening due to system-level factors such as reduced access to outpatient mental health services.  In implementing suicide screening and interventions into pediatric EDs, two questions often emerge: 1.) How would a program impact ED process and flow (feasibility)? and; 2.) How will parents and patients react to questions about suicide on their ED visit (acceptability)? 

Methods: Results from a multi-site instrument development study of suicide screening across three pediatric EDs will be presented.  Feasibility was assessed by length of stay in the ED and prevalence of suicidal ideation and behavior.  Acceptability was assessed by consent to participation by parents and through patient opinions on universal suicide screening from the following question: “Do you think ER nurses should ask kids about suicide/thoughts about hurting themselves, why or why not?” A qualitative analysis of patient responses to this question was conducted using NVivo8.0.

Results:  Responses from 524 participants (10-21 years), who entered the ED for psychiatric or medical reasons, will be presented.  Feasibility: A positive response on a suicide screen was not significantly associated with increased length of stay in the ED.  Of the patients entering the ED for medical reasons (n = 344), 4% (n = 14) had clinically significant suicidal ideation as measured by the Suicide Ideation Questionnaire (SIQ).  Acceptability: The majority of parents consented to have their child participate in this study, while 8% (n = 22) expressed concerns about their child being asked about suicide. The majority of patient participants (93%) agreed that nurses should ask patients about suicide in the ED.  Qualitative themes related to detection, prevention and social support will be highlighted.  

Conclusions:  Suicide screening in the pediatric ED is feasible for the ED system of care and acceptable to patients.  The underlying prevalence of clinically significant ideation in patients in the ED for medical reasons signals a possible opportunity for better identification and preventative intervention. Lessons learned from this experience will be discussed for researchers and clinicians considering similar screening programs in their ED settings.