Universal Suicide Risk Screening in Teens

This article responds to a recent recommendation statement from the United States Preventive Services Task Force (UPSTF) on universal suicide risk screening among children and teens. The UPSTF found that existing research is inadequate to definitively support universal screening for suicide risk among youth, though it does support universal screening for anxiety and depression. This approach conflicts with recommendations of the American Academy of Pediatrics, as well as those developed by the American Foundation for Suicide Prevention in collaboration with the National Institute of Mental Health.

In responding to the UPSTF statement, this article provides a compelling evidence-based argument in favor of universal suicide screening for youth, outlining four key points on which the authors disagree with the UPSTF statement’s findings:

1. The UPSTF statement asserts that there are no validated instruments that can be used to measure suicide risk. However, both the Ask Suicide-Screening Questions(ASQ) and the Computerized Adaptive Screen for Suicidal Youth(CASSY) have been shown to accurately predict suicidal behavior and future emergency department visits for suicide-related behaviors among youth. Research has consistently demonstrated the accuracy of these standardized measures compared to clinician or expert interviews of youth.
2. The USPTF statement claims that there is insufficient literature to determine the risks of screening youth for suicide. However, a meta-analysis of 13 studies, including 4 studies that involved a total of 2,915 adolescents, determined that screening did not increase risk for suicidal behavior or result in psychological stress.
3. While the USPTF recommendation for universal depression screening for youth may help clinicians identify suicide risk, using instruments specifically designed to assess suicide risk are more accurate than screening for depression alone.
4. Universal screening for suicide risk in clinical settings, such as at primary care visits and in emergency departments, may identify patients at risk of suicide who might otherwise be missed. Youth who screen positively for suicide risk are more likely to have a history of at least one other mental health disorder and would benefit from suicide screening even if it yields a false positive result.

The authors conclude that additional research and evaluation of self-report screening via alternative screening methods would be beneficial. Machine learning algorithms derived from health records can be useful adjuncts to suicide screening. Such algorithms can improve identification of youth who may screen negative for suicide risk, but subsequently make a suicide attempt or die by suicide. For example, research has shown that suicidal thoughts are a less accurate predictor of suicide attempts among Black youth than among White youth.

Bridge, J. A., Birmaher, B., Brent, D. A. (2023). The case for universal screening for suicidal risk in adolescents. Pediatrics, 151(6), e2022061093. https://doi.org/10.1542/peds.2022-061093.

References

1.  American Academy of Pediatrics & American Foundation for Suicide Prevention. (2023). Suicide: Blueprint for youth suicide prevention. https://www.aap.org/en/patient-care/blueprint-for-youth-suicide-prevention/
2. Congressional Black Caucus Emergency Task Force on Black Youth Suicide and Mental Health. (2020). Ring the alarm: The crisis of Black youth suicide in America [Report]. https://watsoncoleman.house.gov/imo/media/doc/full_taskforce_report.pdf