Screening for Suicide Risk in Pediatric Medical Inpatient Units: Implications for Clinicians

Background: Medical inpatients, especially youth, are at increased risk for suicide. Early detection of suicide risk is a critical prevention strategy.  Little is known about the feasibility of implementing universal screening practices on inpatient medical units, and whether nurses and patients in this setting have favorable opinions regarding universal screening. The purpose of this presentation is to discuss the feasibility of implementing standardized suicide risk screening in hospital units and discuss these findings within the context of the social worker’s role in screening medically ill patients for suicide risk.  Feasibility was assessed in three domains: 1) Prevalence: Are self-reported suicidal ideation and behavior prevalent enough to warrant screening? 2) Practicality: Can patients who screen positive for suicide risk be managed effectively without straining mental health resources? 3) Provider and patient opinion: Do patients and providers support suicide risk screening on the inpatient medical unit?

Methods: As part of a larger multisite suicide risk screening instrument validation study, pediatric medical inpatients from an urban teaching hospital, ages 10-21 years old, were screened for suicide risk. In order to capture provider opinion, an electronic survey was distributed to all nursing staff treating the same sample of patients to assess comfort level with subject matter and opinions about screening. Participants and nurses were asked “Do you think nurses should ask kids about suicide while they are in the hospital? Why or why not?”  

Findings: 200 pediatric medical inpatients and 64 nurses participated in the study. 10.5% of pediatric participants (n=21) reported recent suicidal ideation and/or past suicidal behavior. All patients who endorsed recent ideation or past behavior received follow-up care in line with the hospital’s standard of care guidelines. The vast majority of both patients (87.5%) and providers (84%) were in favor of screening for suicide risk.  Discrepancies between patient and provider samples also emerged.  Over half of the participating nurses reported discomfort with assessing for suicide risk. Nurses reported that major barriers to screening for suicide risk included parent presence (77.1%), perceived discomfort of patient (59.0%), perceived parent discomfort (59.0%), nurses’ own discomfort (44.3%), and burden of time (24.6%).

Conclusions.  Prevalence of suicide risk was high enough to warrant screening, but low enough that it only resulted in roughly one extra mental health evaluation per week during the data collection period. Both patients and providers agreed that nurses should be asking adolescent medical inpatients about suicide risk.  Given that social workers are the leading providers of mental health services in the US and the nature of social work is interdisciplinary, social work professionals are in a unique position to contribute to suicide prevention initiatives that involve collaboration with other disciplines, such as nursing. These findings present an opportunity for social workers to become involved with the creation of a more patient-centered and coordinated health care system. These findings will inform setting-based implementation strategies for addressing the public health issue of youth suicide.