Adolescent Suicide Risk Screening: The Effect of Communication About Type of Follow-Up on Adolescents' Screening Responses

Abstract

This experimental study examined the effect of communication about type of screening follow-up (in-person follow-up vs. no in-person follow-up) on adolescents' responses to a self-report suicide risk screen. Participants were 245 adolescents (131 girls, 114 boys; ages 13–17; 80% White, 21.6% Black, 9.8% American Indian, 2.9% Asian) seeking medical emergency services. They were randomized to a screening follow-up condition. Screening measures assessed primary risk factors for suicidal behavior, including suicidal thoughts, depressive symptoms, alcohol use, and aggressive/delinquent behavior. There was no main effect of follow-up condition on adolescents' screening scores; however, significant interactions between follow-up condition and public assistance status were evident. Adolescents whose families received public assistance were less likely to report aggressive-delinquent behavior if assigned to in-person follow-up. Adolescents whose families did not receive public assistance reported significantly higher levels of suicidal ideation if assigned to in-person follow-up. Findings suggest that response biases impact some adolescents' responses to suicide risk screenings. Because national policy strongly recommends suicide risk screening in emergency settings, and because screening scores are used to make critical decisions regarding risk management and treatment recommendations, findings indicate the importance of improving the reliability and validity of suicide risk screening for adolescents.

Acknowledgments

Ryan M. Hill is now at the Department of Psychology, Florida International University. Henry A. Wynne is now at the Department of Psychology, Arizona State University.

This research was supported by a NIMH Mid-Career Investigator Award (K24 MH077705) to Cheryl A. King. We acknowledge Adam Horwitz, Danielle Busby, and Kevin Callender for their assistance with data collection in the Emergency Department; Zhuqing Liu for her help with data analysis; and the patients and families that participated in this study.

Notes

Note: Ns are 112 for IPF and 133 for NF for RADS-2SF; Ns are 111 for IPF and 133 for NF for SIQ-JR, Aggression/Delinquency, and AUDIT-C. For race, 27 participants were excluded, as they identified as either both Black and White or as another race. RADS-2SF = Reynolds Adolescent Depression Scale-2: Short Form; SIQ–JR = Suicidal Ideation Questionnaire–Junior; AUDIT-C = Alcohol Use Disorders Identification Test; IPF = in-person follow-up; NF = no in-person follow-up; PA = Public Assistance.

Note: Values enclosed in parentheses represent mean square errors; effect sizes are Cohen's d estimates. RADS-2SF = Reynolds Adolescent Depression Scale-2: Short Form; SIQ–JR = Suicidal Ideation Questionnaire–Junior.