Universal screening helps identify adolescents at risk for suicide

Universal screening helped identify high school students at risk for suicide and made them more likely to engage in mental health treatment, according to study findings published in The Journal of Pediatrics.

Deepa L. Sekhar, MD, MSc, an associate professor of pediatrics at Penn State College of Medicine and executive director of Penn State PRO Wellness, and colleagues conducted a secondary analysis of the Screening in High Schools to Identify, Evaluate and Lower Depression study, in which high school students were surveyed regarding their mental state.

In that study, the researchers used the Patient Health Questionnaire-9 (PHQ-9), “which is a depression screening tool,” Sekhar said. “Item 9 of that survey asked about suicide risk, and this was the question that was the hardest for our school partners.”

Students who answered item 9 positively required same-day follow-up, which can be difficult for schools with limited resources and staff, Sekhar said.

“One of the questions that came up with our school partners was, ‘Could we do the depression screening without this question?’ And that was the question that the study was really designed to answer,” Sekhar said.

The analysis included 12,909 students in 14 high schools in Pennsylvania. At seven schools, students in grades 10 and 12 received universal screening. At the remaining seven, students in grades 9 and 11 received universal screenings students in grades 10 and 12 received targeted screening.

The researchers found that students in the universal screening arm had 7.1-fold greater odds (95% CI, 5.7-8.8) of being identified as at risk for suicide, 7.8-fold greater odds (95% CI, 4.6-13.1) of follow-up needs and 4-fold greater odds (95% CI, 2-7.9) of initiating mental health treatment.

All students who were identified as “at risk” for suicide were referred to the state-mandated student assistance program, which determined follow-up procedures.

“We have to partner with many community-based organizations and schools for the screening work we're doing,” Sekhar said. “I'm a primary care pediatrician, and I screen adolescents routinely for depression and suicide risk and anxiety in the office setting. But the fact is that less than half of adolescents ever come into the primary care office for preventive care, so they're not getting screened [for depression]. And there's been other data to suggest even when they do come in, there are disparities in which adolescents get screened. So we're missing a lot of kids.”

In a press release, Sekhar noted that the PHQ-9 is a screening tool for major depressive disorder.

“Our study confirms the value of universal screening and suggests that a suicide-specific risk assessment would have even greater impact on treatment initiation for identified youth,” Sekhar said.

References:

Suicide risk screening in high schools successfully identifies at-risk students. https://www.psu.edu/news/research/story/suicide-risk-screening-high-schools-successfully-identifies-risk-students/ . Published Jan. 31, 2023. Accessed Feb. 2, 2023.