Abstract: Screening Pediatric Medical Patients for Suicide Risk in the Inpatient Medical/Surgical Setting (Society for Prevention Research 25th Annual Meeting)

Schedule:

Thursday, June 1, 2017

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

* noted as presenting author

Abigail M. Ross, PhD, Assistant Professor, Fordham University Graduate School of Social Service, New York, NY

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

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

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

Jarrod T. Smith, BA, Post-Bac Research Assistant, NIMH, Bethesda, MD

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

Introduction

Feasibility and acceptability of screening for suicide risk have been established in the pediatric emergency department (ED) and the outpatient primary care setting; however, there has been limited information for pediatric inpatient medical units. Screening in the hospital setting may lead to earlier identification and treatment of high-risk youth. Nevertheless, before suicide risk screening protocols can be implemented in hospitals, it is essential to determine whether such efforts are feasible.

Aims

The purpose of this study was to establish feasibility of screening for suicide risk among pediatric medical/surgical inpatients in the following domains of acceptability, prevalence, practicality, and favorable patient opinions.

Methods

As part of a multisite instrument validation study, patients 10-21 years old hospitalized on inpatient medical/surgical units at two large pediatric hospitals in Boston, MA and Washington, D.C. were recruited to take part in suicide risk screening. Participants were administered a battery of self-report questionnaires including the ASQ and the gold standard Suicidal Ideation Questionnaire (SIQ) to measure clinically significant suicidal thoughts and lifetime suicidal behavior. All patients who screened positive on either the ASQ or the SIQ received a follow-up mental health evaluation, and patient safety was managed as clinically appropriate. Feasibility was assessed by collecting data on recruitment rates, utilization of mental health resources, and patient opinions about suicide risk screening. Descriptive statistics are reported. This study was approved by the institutional review boards at the National Institute of Mental Health and Boston Children’s Hospital, and Children's National Medical Center.

Main Findings

Acceptability: Of the 541 patients approached, 400 (74%) agreed to participate. The study population was largely female (59%) and white (47%), with a mean age of 15.2 years (SD=2.9). See Table 1 for further demographic characteristics. Prevalence: Fifty-eight patients (14.5%) screened positive for suicide risk, as assessed by the ASQ and/or SIQ. Thirty-three patients (8.3%) reported a previous suicide attempt. Practicality: All patients who screened positive for suicide risk received a mental health evaluation. The mental health referrals for positive screens equated to roughly one extra psychiatric consultation per week during the data collection period. Patient Opinions:The majority of participants (79%) agreed that nurses should regularly screen pediatric patients for suicide risk in the hospital.

Discussion

Screening pediatric medical/surgical inpatients for suicide risk was found to be feasible in several domains. Results highlight that routine screening on the inpatient unit can help identify at-risk patients and allow a bridge to much needed mental health resources. Medically ill young people offered revealing comments describing the importance of prevention through proactive inquiry. These data lend further evidence to the importance of screening youth for suicide risk in the medical setting.

Abstract: Screening Pediatric Medical Patients for Suicide Risk in the Inpatient Medical/Surgical Setting (Society for Prevention Research 25th Annual Meeting)

404 Screening Pediatric Medical Patients for Suicide Risk in the Inpatient Medical/Surgical Setting