Tool can aid clinicians in discovering and assessing suicidality

We like to imagine that childhood is the time of life to be carefree and without worry. The belief is at odds with the facts that suicide is the second leading cause of death for people aged 10 to 24 years and accounts for 20% of all deaths in that age group. Among children aged 10 to 14, it is the second leading cause of death among male children and the third leading cause of death among female children. It’s difficult to think about, but it’s also the 10th leading cause of death for children aged 5 to 10 years. Screening for suicidality is a necessity to help protect patients. In her presentation “Tools to assess and manage suicidality in youth” at the virtual 2020 American Academy of Pediatrics National Conference & Exhibition, Khyati Brahmbhatt, MD, associate clinical professor at the University of California, San Francisco, provided tools to help pediatricians screen for such thoughts.

Brahmbhatt first spoke of the challenge that exist for addressing suicide in the pediatric patients. Among patients with suicidal thoughts, only 29% will share this fact with an adult without being prompted. Eighty percent of pediatric patients who die by suicide were seen by a health care provider within the year preceding their death and 40% were seen by a health care provider within the month before their death. Often these patients were not asked about suicidality, which she speculated was due to clinicians feeling like they lack the tools to address suicide risk.

To aid in screening for suicide, she recommended setting up a pathway, which includes a brief initial screen that can take less than a minute, a brief suicide safety assessment that takes roughly 10 minutes, and a full mental health evaluation that takes about 30 minutes. She used the National Institute of Mental Health’s Ask Suicide-Screening Questions Suicide Risk Screening Tool for the initial assessment. It has 5 yes or no questions that ask about recent history of suicidality as well as whether the patient had made any suicide attempts. Patients who respond with all negative answers have a negative screening. No response to any questions is a nonacute positive screen and any yes to questions 1 to 4 is a positive screen. Question 5 is used to determine if the suicidality is nonacute or acute.

For patients who have a positive risk, the next step is to run the Ask Suicide-Screening Questions Brief Suicide Safety Assessment. Using the assessment involves praising the patient for being forthcoming about the suicidal thoughts and then assessing them for frequency of the thoughts, whether the patient has a suicide plan, asking about various symptoms, discussing social supports, and talking about past behaviors. Clinicians should then interview the patient and parent together, although the parent should only be included if the patient is comfortable, to find out the parent’s perspective. Following the interview, the patient and clinician should develop a safety plan that may involve discussing things that need to be restricted or removed in the home, as well as asking the patient if he or she believes that she needs help to keep safe. Clinicians then select the disposition plan and offer 24/7 hotline resources to all patients. At this point, some patients may need a full mental health evaluation.