Standardized screening for suicidal adolescents in primary care

Abstract

Objective: To determine if brief standardized screening for suicide risk in pediatric primary care practices will increase detection rates of suicidal youth, maintain increased detection and referral rates, and be replicated in other practices.

Patients and methods: Physicians in 3 primary care practices received brief training in suicide risk, and 2 standardized questions were inserted into their existing electronic medical chart psychosocial interview. The questions automatically populated for all adolescents aged 12.0 to 17.9 years. Deidentified data were extracted during both intervention trials and for the same dates of the previous year. Referral rates were extracted from social work records.

Results: The rates of inquiry about suicide risk increased 219% (clinic A odds ratio [OR]: 2.04 [95% confidence interval (CI): 1.56-2.51]; clinic B OR: 3.20 [95% CI: 2.69-3.71]; clinic C OR: 1.85 [95% CI: 1.38-2.31]). The rate of case detection increased in clinic A (OR: 4.99 [95% CI: 4.20-5.79]), was maintained over 6 months after the intervention began (OR: 4.38 [95% CI: 3.74-5.02]), and was replicated in both clinic B (OR: 5.46 [95% [CI: 3.36-7.56]) and clinic C (OR: 3.42 [95% CI: 2.33-4.52]). The increase in case detection was 392% across all 3 clinics. Referral rates of suicidal youth to outpatient behavioral health care centers increased at a rate equal to that of the detection rates.

Conclusions: Standardized screening for suicide risk in primary care can detect youth with suicidal ideation and prompt a referral to a behavioral health care center before a fatal or serious suicide attempt is made.