Patients’ Opinions of Suicide Risk Screening in a Pediatric Primary Care Clinic

Introduction:

Youth suicide is an international public health threat. According to the World Health Organization (2014) and the Centers for Disease Control and Prevention (2014), suicide was recently ranked as the second leading cause of death for youth worldwide.

Ninety percent of youth with suicidal ideation, plan or intent were seen by a primary care provider within the previous year (McCarty et al., 2011). While the primary care setting is a critical location for early detection and intervention, many institutions are reluctant to adopt the practice due to concerns about the appropriateness of the setting and how the practice would be received by patients. The aim of this qualitative study is to describe pediatric patients’ opinions about suicide risk screening in the primary care setting.

Methods:

As part of a larger instrument validation study, children and adolescents aged 10-21 years, inclusive, presenting to a primary care clinic in a large urban pediatric hospital were asked their opinions of suicide risk screening. Specifically, patients were asked the following questions:

1) Has anyone ever asked you about suicide before? 2) Do you think nurses or doctors should ask kids or teenagers about suicidal thoughts while they are in a primary care clinic?

3) Why or why not? Qualitative data was analyzed in NVivo 10.2 using thematic analysis (Braun & Clarke, 2006).

Findings:

To date, a total of 121 participants completed a series of self-report measures, including a demographic questionnaire, the Ask Suicide-Screening Questions (ASQ), the Suicidal Ideation Questionnaire (SIQ) and the Patient Health Questionnaire-Adolescent Version (PHQ-A). Fifty-four percent (N=65) of the sample was female, the average age was 16.6 (SD: 2.3) and the sample was diverse: 36.3% Latino, 27.2% Black, 17.3% White, 9.9% mixed, 2.4% Asian/Pacific Islander, and 6.6% Other. Only 44.6% of the sample (N=54) reported that they had been asked about suicide prior to their current visit. The majority of patients (96.7%) supported universal screening in primary care. Salient themes characterizing reasons in favor of universal screening included prevention, safety, and healthcare provider responsibility.

Conclusions & Implications:

Results indicate that the majority of pediatric primary care patients support screening in primary care clinics and have not been screened for suicide risk in any setting. Overwhelmingly, youth noted the importance of suicide risk screening and comfort with answering questions about suicidal thoughts and behaviors. Implications for primary-care based strategies for addressing the public health issue of youth suicide will be discussed.