Press release
Wednesday, February 3, 2021
Researchers have developed a computer adaptive screen to test young people at risk for suicide. The screen, known as the computerized youth suicide change screen (CASSY), contains an average of 11 questions and correctly identified 82.4% of youth who went on to try to suicide in the three months following screening. The findings suggest that this screener could be an easy-to-use way for providers to detect the risk of juvenile suicide in emergency department situations. The findings, funded by the National Institute of Mental Health (NIMH), part of the National Institutes of Health, appear in the journal JAMA Psychology.
“No young person should die by suicide, which is why we have bent the curve in suicide rates to make it an important area of research for our institute,” said Joshua A. Gordon , MD, Ph.D., director of NIMH. “The CASSY screener represents an important step forward in identifying those teenagers at risk of suicide, so that they can be connected to the emergency support services they need.”
Adolescent suicide rates have risen over the past two decades. In 2019, 1,580 teenagers between the ages of 12 and 17 died by suicide, a rate of 6.3 per 100,000, according to data from the Centers for Disease Control and Prevention. With approximately 40% of adolescents who die by suicide being treated for mental health concerns, extensive screening for suicide risk is important to ensure that at-risk adolescents are not to lose.
Emergency departments are a common place for young people to access emergency care, suggesting that this environment is the best way to implement universal screening for suicide risk. Challenges to this type of implementation include the time constraints and budget constraints faced by many emergency departments. A suicide screen that identifies the risk of suicide quickly and accurately would help providers implement universal screening in these situations.
Although there are currently short suicide questionnaires that detect suicide risk, these screens usually have only moderate sensitivity (test ability to correctly identify people with the targeted condition) or specificity (ability to test to correctly identify people without the target position.). The new screener uses a transformative approach that allows for the sensitivity of screening devices to be improved, as it uses a person’s initial responses to help adapt and personalize the latest queries – such as then the screener “adjusts” to try to accommodate everyone who can.
In the first phase of the study, led by Cheryl King, Ph.D., professor of psychiatry at the University of Michigan, Ann Arbor, researchers employed young people ages 12 to 17 in co- work with 13 emergency departments that are part of the U.S. Pediatric Emergency Care Applied Research Network (PECARN). Adolescents who entered an emergency department at the study sites during randomly selected movements completed self-report questionnaires assessing suicidal ideation and rumination; history of suicide attempts; self-harm; depression; despair; alcohol and drug abuse; family, school, and social ties; physical and sexual abuse; and other items found to be associated with suicide risk. The youngsters and their parents then received follow-up calls three months after this initial screening to find out if the youngsters had tried to end their lives in recent months.
The researchers used this data to create the CASSY. In the second phase of the study, the researchers tested the ability of CASSY to predict suicide risk in a new set of adolescents, ages 12 to 17, which led to 14 PECARN emergency departments and one emergency department Indian Health Service. Young people completed the CASSY as well as a subset of the questionnaires given to participants in the first phase of the study. Similarly, to phase 1 of the study, adolescents and their parents were contacted three months after completion of the initial screens to determine if the adolescents had attempted to end their lives in the last three months.
When researchers looked at the data from the second phase of the study, they found that 6% of participants had attempted suicide in the three months between initial screening and follow-up. CASSY correctly identified 82.4% of adolescents who attempted suicide in the three months post-screening and 72.5% of adolescents who did not attempt suicide in the three months post-screening.
“While we are trying to prevent more youth suicide, identifying the number of young people at risk should be a priority. Nonetheless, emergency departments are often challenged by limited resources for mental health continuity, so that universal screening becomes more feasible if the false positive level of the screen is relatively low, ”Said King. “Because CASSY is centralized, it enables hospitals to change the sensitivity and specificity of the screen, balancing the positive and negative false alarms to respond to the resource needs of each emergency department.”
There were some limitations in the study. For example, the data were collected in emergency departments linked to academic institutions and may not be representative of all emergency departments. In addition, a large proportion of adolescents who were asked to participate in initial screening declined. Of those who participated in the initial screening, not all responded to communication attempts at the three-month follow-up point.
Despite these limitations, the findings suggest that CASSY provides a valuable tool for identifying young people at risk of suicide in the months following screening and may not. help emergency workers identify people who need more support and suicide prevention services.
The researchers note that, moving forward, it will be important to develop triage recommendations for CASSY and collaborate with emergency departments to identify the best screening implementation strategies.
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About the National Institute of Mental Health (NIMH): NIMH’s mission is to transform the understanding and treatment of mental illness through basic and clinical study, paving the way for prevention, recovery, and cure. For more information, visit the NIMH website.
About the National Institutes of Health (NIH):
NIH, the nation’s medical research agency, comprises 27 Institutes and Centers and is part of the U.S. Department of Health and Human Services. NIH is the leading federal agency that conducts and supports basic, clinical, and translational medical examination, and examines the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.
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