Abstract: Abstract of Distinction, ECPN poster contestant: Identifying Suicide Risk on Pediatric Inpatient Medical Units: Is Depression Screening Good Enough? (Society for Prevention Research 25th Annual Meeting)

Schedule:

Thursday, June 1, 2017

Columbia A/B (Hyatt Regency Washington, Washington, DC)

* noted as presenting author

Elizabeth Lanzillo, BA, Postbaccalaureate IRTA, National Institute of Mental Health, Bethesda, MD

Daniel Powell, BA, Prior Postbaccalaureate IRTA; Current medical student, National Institute of Mental Health, Bethesda, MD

Elizabeth Wharff, PhD, MSW, Instructor of Psychiatry/Research Scientist/Assistant Professor at Harvard Medical School, Boston Children's Hospital, Boston, MA

Abigal Ross, PhD, Assistant Professor, Fordham University Graduate School of Social Service, New York City, NY

Martine Solages, MD, Psychiatrist, Children's National Medical Center, Washington, DC

Jeffrey A. Bridge, PhD, Associate Professor of Pediatrics, Ohio State University, Columbus, OH

Erina White, PhD, Research Social Worker, Boston Children's Hospital, Boston, MA

Sally Nelson, RN, MEd, Nursing leader, Boston Children's Hospital, Boston, MA

Maryland Pao, MD, Clinical Director, National Institute of Mental Health, Bethesda, MD

Lisa M. Horowitz, PhD, MPH, Staff Scientist/Pediatric Psychologist, National Institute of Mental Health, Bethesda, MD

Background

Suicide is the second leading cause of death for youth ages 10-24. Medically ill youth are at a heightened risk for suicidal thoughts and behavior. The Joint Commission recommends suicide risk screening in all areas of hospitals, however, suicide risk screening is not routine in most hospitals. One alternative in some medical settings is to screen for depression in lieu of a formal suicide risk screen. The Patient Health Questionnaire (PHQ-A) is a commonly utilized depression screen that includes an item that is purported to measure suicidal ideation and self-harm (Item #9). However, recent studies suggest that depression screening alone may not be adequate to identify medical patients at risk for suicide.

Objective

This study aims to determine if depression screening can detect suicide risk in pediatric medical inpatients who screen positive for suicide risk on other suicide-specific measures.

Methods

As part of a larger instrument validation study, a convenience sample of medical inpatients, ages 10-21, were recruited from two pediatric hospitals. Participants completed a self-report screening measure for depression (PHQ-A), two validated suicide risk screening tools, and a demographics/exploratory variable questionnaire. Univariate and multivariate statistics were calculated to examine the relationship between screening positive for depression and suicide risk.

Results

400 inpatients participated as part of the larger study (52% female; 47% white; mean age 15.2 ± 2.9 yrs). 48 patients (12%) screened positive for depression only, 17 (4.3%) screened positive for suicide risk only, and 41 (10.3%) screened positive for both depression and suicide risk. After controlling for demographic factors, patients who screened positive for depression were 12 times more likely to also screen positive for suicide risk (95% CI: 6.1-23.9, p<.001). Of the patients that screened positive for suicide risk, 14 patients (24.1%) did not endorse Item #9 on the PHQ-A.

Discussion

In this sample, the PHQ-A did not identify all patients at risk for suicide. Relying on depression screening alone would have missed 14 participants at risk for suicide. Although there is a clear overlap between depression and suicide risk, some medical patients at risk for suicide may be under-detected if depression screening is used as a proxy for identifying suicide risk. Asking directly about suicide may identify more patients at risk. Future studies examining differences between patients who screen positive for “depression and suicide risk” and “suicide risk only” are warranted.

Conclusion

Depression screening may not identify all medical patients at risk for suicide. Non-mental health clinicians require validated suicide risk screening tools to adequately assess suicide risk in the medical setting.

Abstract: Abstract of Distinction, ECPN poster contestant: Identifying Suicide Risk on Pediatric Inpatient Medical Units: Is Depression Screening Good Enough? (Society for Prevention Research 25th Annual Meeting)

372 Abstract of Distinction, ECPN poster contestant: Identifying Suicide Risk on Pediatric Inpatient Medical Units: Is Depression Screening Good Enough?