O1015: A Call to Action: Suicide Risk Screening Should Include Youth ages 10 and 11 Years-Old

Background: Youth struggling with suicide seek care in pediatric emergency departments (PED) at alarming rates. The Joint Commission (TJC) requires suicide risk screening in PEDs. Current guidelines suggest screening youth 12 years and older, however suicide is a leading cause of death starting at age 10 and recommended screening tools are for ages 10 and older. We sought to compare PED patient demographics of 10-and-11-year-olds (younger) to 12–18-year-olds (older) who screened positive and determine the predictability across age groups.

Methods: A retrospective chart review including universally screened 10–18-year-olds in an urban PED from 2019-2022 and at least 6 months of follow-up data after first screening encounter. We compared patient characteristics between age groups using logistic regression. We calculated performance of positive screens in predicting subsequent suicide attempts and time-to-event (suicide attempt) by age group.

Results: Our sample included 22,185 records of uniquely screened 10-18-year-olds; 17,903 had at least 6 months of follow-up data. Patients were 79% older, 48% male, 40% Non-Hispanic White, and 16% were seen for a mental or behavioral health (M/BH) chief complaint at screening. More than half (53%) were covered by Medicaid. Almost 1-in-6 patients (16%) had a positive screen. A total of 492 (3%) patients had an identifiable suicide attempt following initial screens (Table 1).
Younger patients were more likely Hispanic or Latine, covered by Medicaid, and less likely to have a M/BH complaint and a positive screen (ps < 0.001). Younger patients were marginally less likely to have a subsequent suicide attempt: 62 (2%) younger patients and 430 (3%) older patients (p=0.05). Younger positive-screen patients were more likely male and covered by Medicaid (ps < 0.002; Table 2).
Screening identified 47% (N=27) of younger patients that attempted suicide and 60% (N=259) of older patients, but did not reach statistical significance (p=0.06). Almost 10% of positive-screen patients (N=288) had an attempt which did not differ by age (p=0.38).
Most patients without positive screens did not attempt suicide but specificity was higher in younger (92%) versus older patients (83%;p < 0.001). Characteristics of positive-screen patients that attempted suicide did not differ by age group (ps>0.29), but the median number of months between screening and attempt was half that for older (4 months) versus younger patients (8 months;p=0.03).

Conclusion: Universal suicide screening in PEDs is a critical step in identifying ALL youth in need of life-saving mental health care. In our study, 1-in-6 patients had a positive screen and 1-in-10 of those identified at-risk returned with an attempt; This did NOT differ by age group. Younger patients who screened negative were less likely to return with an attempt, which should reassure providers that we are not increasing their risk by talking about suicide. Youth 10-11-years-old should be screened for suicide risk in PEDs.