Citation

Sekhar DL, Batra E, Schaefer EW, Walker-Harding LR, Pattison KL, Molinari A, Rosen P, Kraschnewski JL, Waxmonsky JG. J. Pediatr. 2022; ePub(ePub): ePub.

Copyright

(Copyright © 2022, Elsevier Publishing)

DOI

10.1016/j.jpeds.2022.07.036

PMID

35944722

Abstract

OBJECTIVE: To evaluate the effectiveness of adolescent suicide risk screening to increase initiation of mental health services via a secondary analysis using data from the SHIELD randomized clinical trial, which evaluated school-based screening for major depressive disorder (MDD). STUDY DESIGN: Students in 14 Pennsylvania high schools were randomized by grade to either: usual school practice of targeted referral for behavior raising concern for suicide risk, or universal screening using the Patient Health Questionnaire-9 (PHQ-9) with any response >0 to item #9 regarding suicide risk considered positive. Students identified in either arm were referred to the Student Assistance Program (SAP), which is mandated in all Pennsylvania schools. SAP determined follow-up. Study groups were compared using mixed effects logistic regression.

RESULTS: Participants included 12,909 students with 6,473 (50.1%) randomized to universal screening. Students were 46% female and 43% Hispanic or non-Hispanic Black. Adolescents in the universal screening arm had 7.1 times higher odds (95% CI 5.7-8.8) of being identified as at risk for suicide, 7.8 times higher odds (95% CI 4.6-13.1) of follow-up needs, and 4.0 times higher odds (95% CI 2.0-7.9) of initiating mental health treatment.

CONCLUSIONS: Although the PHQ-9 is a MDD screening tool, its use in universal screening increased identification and treatment initiation for adolescents at risk for suicide. This confirms the value of universal screening, and suggests a suicide-specific risk assessment would have even greater impact on treatment initiation for identified youth.

Language: en

Keywords

mental health; adolescent suicide; school-based screening