Screening for Suicide Risk with Pre-Teens in the Pediatric Emergency Department

Introduction In 2015, more than 5,900 youth died by suicide (CDC, 2016). Although pre-teens have a lower suicide rate than older adolescents, the suicide rate continues to increase among youth ages 10 to 12 and suicide is the third leading cause of death for this age group (CDC, 2016). This study aims to describe the prevalence of screening positive for suicide risk among a sample of pre-teens (ages 10-12 years) presenting to the emergency department (ED) to determine if screening youth under age 13 for suicide risk in this setting is warranted.

Methods This study is a sub-analysis of data collected as part of a multisite, cross-sectional study that developed the Ask Suicide-Screening Questions (ASQ) instrument (Horowitz et al., 2012). Participants were pediatric patients ages 10 to 21 years who presented to EDs at three urban hospitals. Patients were administered a battery of measures, including the ASQ and the criterion-standard Suicidal Ideation Questionnaire (SIQ). Patients who answered affirmatively to any of the four ASQ questions, and/or scored above the SIQ cutoff score were considered a positive screen for suicide risk and required a follow-up mental health assessment. This sub-analysis specifically examines the suicide risk positive screen rate among patients ages 10-12 years, inclusive, presenting to the ED with psychiatric and medical chief complaints.

Results A total of 524 pediatric patients presented to the ED participated as part of the larger study. The sample included 79 patients between the ages of 10 and 12 years old (hereafter referred to as “pre-teens”; 60.8% male; 49.4% white; mean age 11.2 ± 0.8 years). Among the pre-teens, 53.2% (42) presented with medical chief complaints and 46.8% (37) presented with psychiatric chief complaints. The positive screen rate for all pre-teens was 29.1% (23/79). Over half (54.1%, 20/37) of the 37 pre-teen patients presenting with psychiatric chief complaints screened positive for suicide risk and 7.1% (3/42) of the pre-teens presenting with medical chief complaints screened positive. Of note, 17.7% (14/79) of all pre-teens reported a previous suicide attempt, including seven 10-year-old patients, indicating that at least 8.9% of patients attempted suicide at age 10 or younger.

Conclusions In this sample of pre-teen patients presenting to the ED, over one-third of patients screened positive for suicide risk. Although suicide is a low base-rate event in this age group, this analysis demonstrates that pre-teens think about suicide and engage in suicidal behavior at a rate that warrants further study. Approximately 18% of pre-teen ED patients reported a previous suicide attempt, with at least half of these patients reporting an attempt at or before age 10. A previous suicide attempt is the greatest risk factor for future suicidal behavior; therefore, identification of patients with past attempts is critical to suicide prevention. Notably, 7% of pre-teens presenting with medical chief complainants screened positive, highlighting the importance of screening all pre-teen patients as young as 10 years for suicide risk in the ED, regardless of their presenting complaint.