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How Accurate Are Teen Suicide Risk Screening Tools?

February 15, 2024

Editor’s Note: Beth Dworetzky's son was born with a complex heart condition. She and her son navigated a fragmented health care system for 31 years until his death in October 2021. - Cara L. Coleman, JD, MPH, Associate Editor, Pediatrics

Family Connections with Pediatrics

Teens face many tough issues—including those related to school, gun violence, peer pressure, social media, the shift to adult life, and more—that can affect their mental health. A 2024 Kaiser Family Foundation report found that 1 in 5 teens have anxiety or depression and that suicide is the second leading cause of death for teens. This month’s Pediatrics includes a review of screening tools that health providers use to assess the risk of suicide in teens, in an article entitled, "Suicide Risk Screening Tools for Pediatric Patients: A Systematic Review of Test Accuracy" (10.1542/peds.2023-064172).

How did the authors study this?

The authors studied 13 suicide risk screening tools for teens, ages 12 and older, to learn:

  • How well each tool identified if a teen was not a suicide risk
  • If the tool was sensitive enough to correctly learn if a teen was at risk or not at risk for suicide
  • If the tool could be used in places, like in primary care or emergency departments (ED), which do not specifically treat mental health
  • If any of the tools might have bias that could affect use and results with teens from diverse cultural and ethnic backgrounds, and who speak a language other than English

The authors also wanted to identify areas for future research.

What did the review find?

There were quite a few findings. Here are a few:

The tools ranged quite a bit, between 50%-100%, in how well they could identify risk of suicide.

  • The Ask Suicide-Screening Questions (ASQ) and the Computerized Adaptive Screen for Suicidal Youth (CASSY) had the most information to support their use in primary care, inpatient settings, EDs, and outpatient settings that were not mental health settings.
  • Future work needs to address race, ethnicity, and culture to ensure findings apply for all teens.
  • Screening tools should be available in multiple languages.
  • Overall, it is important to include screening for teen suicide risk as part of primary care and other health visits.

What can you do with this review?

  1. Share the review with your teen’s doctor. Ask if the office uses a suicide risk screening tool as part of well visits, and if so, which one.
  2. Talk with your teen about their mental wellness, and any anxiety, depression, or thoughts they may have about suicide, and seek mental health support if needed.
  3. Remove firearms from the home, or lock them up.
  4. The Substance Abuse and Mental Health Services Administration (SAMHSA) has a 988 suicide and crisis lifeline. Post the 988 number near the phones in your home and enter it into your and your teen’s cell phones.
  5. Learn more about the 988 Suicide and Crisis Lifeline resources.
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