Systematic Youth Suicide Screening in a General Hospital Setting

Abstract

Abstract Objectives: Adolescent suicide rates have been rising since 1999, and efforts to identify youth at risk with systematic approaches are important in secondary prevention. The Columbia Suicide Severity Rating Scale (C-SSRS) screener is a tool that has demonstrated predictive validity in identifying youth at risk of attempting suicide. Health care settings are key venues where at-risk youth can be identified effectively. Methods: A tertiary hospital in the Northeast U.S. developed a suicide risk protocol, consisting of systematic screening of patients for suicidal ideation/behavior with a screening version of the C-SSRS and a response algorithm based on risk levels derived from the screen. A total of 840 nurses were trained on the C-SSRS Screener, with a response protocol addressing environmental safety and psychiatric consultation. Results: This report focuses on the screening results for adolescents (ages 12–17) within this cohort, occurring over a 11-year period. Posttraining inter-rater reliability on the C-SSRS Screener definitions of ideation and behavior were high and independent of level of education or mental health experience. Of 6126 patients screened in this age group, 9.6% were in the highest risk category, as compared to 0.93% of adults during a 12-month period. Middle adolescents, females, African American and Latino patients, patients with psychiatric diagnoses, and patients with some medical diagnoses were at significant risk. Conclusions: These findings suggest that a systematic screening and clinical response protocol using the C-SSRS screener can potentially enhance the ability to identify suicide risk in the adolescent population in medical surgical hospitals and can focus services on patients with the most need.