Title: Screening for Suicide on a Pediatric Inpatient Medical Unit: Should We Ask Them?
Suicide is a significant public health problem, recently ranked as the 2nd leading cause of death in youth ages 10 to 24. Substantial evidence suggests that individuals who are hospitalized for medical reasons are at increased risk for suicide. Early detection of patients at risk is a critical prevention strategy; however, little is known about the prevalence of suicidality in pediatric medical inpatient populations. Moreover, few studies explore how to ask young patients about their suicidality. To date, research examining suicide screening tools and patient opinions regarding screening practices in pediatric populations has been limited to the Emergency Department (ED) settings. Although results indicate that the majority of pediatric patients support universal screening for suicide in the ED, no studies have explored pediatric medical inpatient opinions about screening for suicide risk. This qualitative study describes pediatric patients’ opinions regarding suicide screening in the inpatient medical setting.
Methods:
This is a sub-analysis of a cross-sectional study of children and adolescents aged 10-21 years, inclusive, receiving medical treatment on a general medical floor in a large urban pediatric hospital. Patient data was collected as part of a multisite suicide screening instrument validation study of the Ask Suicide-ScreeningQuestions (ASQ; Horowitz et al., 2012). Patients were interviewed by two clinical social workers over a period of four months. A total of 200 young patients between the ages of 10 and 21 completed a series of self-report measures, including a demographic questionnaire, the ASQ, the Suicidal Ideation Questionnaire (SIQ) and the Patient Health Questionnaire-Adolescent Version (PHQ-A). In addition, study participants were asked the following questions about screening practices: “Have you ever been asked about suicide before?” and “Do you think nurses should ask kids about suicidal thoughts while they are in the hospital? Why or why not?” Qualitative data was analyzed using thematic analysis. Patient demographics (primary diagnosis, length of stay on unit) were collected through a retrospective chart review.
Findings: Sixty percent (N=120) of the sample was female and average age was 15.44 (SD: 2.8). Seventy percent of the sample was White, 12.5% Latino, 6.5% mixed, 9% Black, and 2% Asian. Fifteen percent of the study sample (N=30) screened positive on the ASQ for risk of suicide. Only 38% of the total sample (N=76) reported that they had been asked about suicide prior to their current inpatient stay. The majority of patients (87%)supported universal screening by nurses who treat patients on hospital medical floors. Salient themes included prevention, safety, and the critical importance of nurses. Demographic, systemic, and clinical variables associated with positive screens on the ASQ will also be described.
Conclusions & Implications:
Pediatric medical inpatients support suicide screening in the hospital setting. Results indicate that the majority of medical adolescent inpatients have not been screened for suicide. Overwhelmingly, youth noted the importance of suicide screening and comfort with answering questions about suicidal thoughts and behaviors. Implications for hospital setting-based strategies for addressing the public health issue of youth suicide will be discussed.