‘Sadly not very surprising’: Many children screen positive for suicide risk

Key takeaways:

• Around 80% of gender-diverse youth screened positive for suicidal ideation during ED encounters.
• Among more than 12,000 total ED encounters, 24% of children had a suicide risk.

WASHINGTON — Nearly one in four children screened positive for suicide risk at a pediatric ED in Chicago during a 3-year period, according to a study presented at the AAP National Conference & Exhibition.

Among transgender and gender-diverse youth, the proportion was even higher: around 80% screened positive for suicide risk, including 10% with active suicidal ideation at the time of ED presentation, researchers found.

In recent years, organizations such as the AAP and AMA have said the United States is in the grips of a national emergency over pediatric mental health, but universal suicide screening — particularly in children — is a relatively new practice, according to one of the authors of the new study.

“The broader goal was to look at this universal suicide screening, because it's been kind of a newer trend in the field to try to capture all youth and really integrate this into general practice,” Amanda N. Burnside, PhD, attending pediatric psychologist at Lurie Children’s Hospital of Chicago, told Healio. “We were really trying to understand if [screening] is helpful. Is there something else we need to be doing?”

Burnside said Lurie Children’s began implementing universal suicide screenings in 2019, and the study traces the electronic medical records of 12,112 ED encounters for children aged 10 years and older from September 2019 to August 2022. In that cohort, 24% of all patients screened positive for suicide risk, Burnside and colleagues found.

Among 565 encounters with patients who identified as transgender or gender-diverse, suicide risk was identified in 78% of encounters, with 10% endorsing active suicidal ideation at the time of presentation.

Over 77% of ED encounters by transgender and gender-diverse youth centered on chief complaints of mental health, and gender-diverse youth were 5.35 times more likely than cisgender youth to screen positive for suicide risk, a discrepancy Burnside described as “jarring and devastating.”

“We work with a lot of transgender and gender-diverse youth at Lurie. We serve a lot of these youth, and I think we were seeing these increased trends, but a lot of the research out there is on school-based populations or those specific clinic populations,” Burnside said.

Ultimately, she said, the results were expected.

“Sadly, [the results were] not very surprising,” Burnside said. “In my experience, just over the last few years, we've seen a really huge increase in the amount of youth presenting with suicide risk and really needing [mental health] services, so it didn't surprise me.”

Burnside said a “sizable portion” of children who identified as high risk were there for a nonmental health chief complaint, “so it really does mean that it's important to be asking these questions for every child that comes through,” Burnside said. “It might be nerve wracking, or a little bit scary to ask these questions to youth. But I feel very strongly that it's part of our job as professionals in the health care field to make sure that we're integrating this as part of our standard practice.”

References:

Burnside A, et al. Suicidal ideation in transgender and gender diverse youth in the emergency department. Presented at: AAP National Conference & Exhibition; Oct. 20-24, 2023; Washington, D.C.

Research finds 1 out of 4 youth screen positive for suicide risk in an emergency department; majority of those who identify as transgender, gender diverse, screen positive. https://www.aap.org/en/news-room/news-releases/conference-news-releases/research-finds-1-out-of-4-youth-screen-positive-for-suicide-risk-in-an-emergency-department/. Published Oct 20, 2023. Accessed Oct. 22, 2023.