Suicide Risk Screening Tools for Pediatric Patients: A Systematic Review of Test Accuracy

Abstract

CONTEXT Health care settings have increasingly adopted universal suicide risk screening tools into nonpsychiatric pediatric care; however, a systematic review examining the accuracy of these tools does not yet exist. OBJECTIVE Identify and review research on the test accuracy of suicide risk screening tools for pediatric patients in nonpsychiatric medical settings. DATA SOURCES PubMed and PsycINFO were searched to identify peer-reviewed articles published before March 23, 2023. STUDY SELECTION Articles that quantified the accuracy of a suicide risk screening tool (eg, sensitivity, specificity) in a nonpsychiatric medical setting (eg, primary care, specialty care, inpatient or surgical units, or the emergency department) were included. DATA EXTRACTION A total of 13 studies were included in this review. Screening tool psychometric properties and study risk of bias were evaluated. RESULTS Sensitivity among individual studies ranged from 50% to 100%, and specificity ranged from 58.8% to 96%. Methodological quality was relatively varied, and applicability concerns were low. When stratifying results by screening tool, the Ask Suicide-Screening Questions and Computerized Adaptive Screen for Suicidal Youth had the most robust evidence base. LIMITATIONS Because of considerable study heterogeneity, a meta-analytic approach was deemed inappropriate. This prevented us from statistically testing for differences between identified screening tools. CONCLUSIONS The Ask Suicide-Screening Questions and Computerized Adaptive Screen for Suicidal Youth exhibit satisfactory test accuracy and appear promising for integration into clinical practice. Although initial findings are promising, additional research targeted at examining the accuracy of screening tools among diverse populations is needed to ensure the equity of screening efforts.