Self-Report of Suicidal Thoughts and Behavior vs. School Nurse Evaluations in Dutch High-School Students

Abstract

Background: Systematic screening to identify adolescents at risk for suicidal behavior is crucial to suicide prevention. Aims: The current practice of screening and follow-up actions taken by school nurses in schools for secondary education in Rotterdam, the Netherlands, was studied. Methods: In Rotterdam, an approach was developed in which, as a standard routine, students are invited to an interview with a school nurse after filling out a youth health survey in classroom setting. This health survey comprised, among other subjects, the Strengths and Difficulties Questionnaire (SDQ) and questions about suicidal thoughts and behaviors. The results from the interviews and the self-report questionnaires of nearly 4000 first-grade students in secondary education were analyzed. Results: The vast majority of invitations were not followed by any action from the school nurse. Also, the majority of students whose self-report led to an “Attention Subject” for the nurse were not considered to be at risk by the nurse. The self-report of recent suicidal thoughts added to the predictive value of emotional distress as measured by the SDQ and other self-report conclusions. Conclusions: This study demonstrates the additional value of self-reported suicidal thoughts for Dutch preventive practices in youth health care.