A state-of-the-art personalized screening tool to better detect juvenile suicide

Suicide rates among American teens have skyrocketed in the past decade, but many at-risk teens are not getting the mental health services they need .

Of course, one of the biggest challenges is identifying the young people who need the most help.

Now, researchers have developed a personalized system to better detect juvenile suicide. The novel, universal screening tool helps carers reliably predict adolescent suicide risk – warning them of who needs ongoing interventions – based on decisions led by Michigan Medicine published in JAMA Psychology.

“Too many young people die by suicide and many at high risk go completely unnoticed and untreated,” says lead author Cheryl King, Ph.D., professor, expert- clinical child psychiatry, and director of Juvenile Depression and Suicide Adolescents and Prevention Research Program in the Department of Psychology at Michigan Medicine.

“About half of young people who die by suicide have never received mental health services and some die on their first attempt at suicide. We have seen an urgent need for it. proactive, universal suicide screening of young people. “

The screening device, called the Adaptive Computer Screen for Youth Suicidal (CASSY), is designed for use in emergency rooms through a short and efficient system that does not disturb care. When a teenager or teenager is admitted for any reason – whether it’s a psychiatric complaint or something unrelated like a sports injury – they fill out a questionnaire on a digital device.

Follow-up questions and the number of questions are based on their responses so that the screening is tailored to the individual patient.

Adolescents will be asked about suicidal thoughts but also other factors that may put them at risk, such as sleep disturbances, trouble concentrating, anxiety, depression and despair, and family and school connection issues. It is the combination of risk factors that determine a score for their suicide risk level.

While the current suicide screening devices are being used, King says, previous research shows that many high-risk young people are not being found. too many of them are endangered, including many that are “wrong things.”

“A different combination of risk factors can put young people at risk,” says King, who is also a child and adolescent psychologist at Michigan Mott’s CS Children’s Medical Hospital and a member of the University of Michigan Injury Prevention Center. “If we write just for suicidal thoughts, we will miss some high-risk teenagers.

“There are many reasons why young people do not share suicidal thoughts, perhaps because they are embarrassed, do not experience the ideas at the time of screening, or have someone responded. the way they did not feel helpful when sharing suicidal thoughts or sensitive information in the past. “

The CASSY system, she says, informs the health care provider in emergency services about the likelihood of a future suicide attempt. It offers thresholds for identifying different levels of risk, from mild to high.

This screening tool has the potential to be a step forward in our effort to develop clinical models of care to appropriately meet the mental health needs of young people. “

Cheryl King, Ph.D., Lead Author

Suicide is the second leading cause of death among U.S. teens, and the suicide rate among teens in the U.S. has grown 62% since 2000. In 2018, the U.S. reported the highest annual number of juvenile suicide deaths involving 1,750 adolescents of age. 12-17.

The algorithm for the computer screening tool was based on data from multiple centers that participated in the Emergency Department Screen for Adolescents at Risk for Suicide, which is funded by the National Institutes of Mental Health.

Emergency departments are well-suited for suicide risk screening, King notes, as nearly 19% of U.S. adolescents visit the ED over a year. ED visits for juvenile suicide risk and self-harm have also recently doubled and are a common place for health services, she says.

The new study included two groups of adolescents ages 12–17 who visited the emergency departments. The CASSY screening tool was developed in the first group with 2,075 adolescents and tested in a second independent group with data from 2,754 adolescents.

In this second group, 165 teenagers (6%) committed at least one suicide attempt over the three months, and the CASSY predicted a risk of suicide attempt with more than 88% inaccuracy over the next three months.

King and his research colleagues are hopeful that many emergency departments across the country will consider incorporating this personalized screening tool into their models of care to improve suicide risk identification and treatment planning.

The improvement comes as national and local experts have shared concerns about loneliness from the COVID-19 pandemic exacerbating mental health issues for teenagers most at risk of anxiety, depression. and suicidal thoughts.

“Improving suicide risk detection through effective screening has the potential to facilitate treatment, reduce morbidity and prevent death among adolescents and young people,” King says.