Identifying Youth at Risk for Suicidal Thoughts and Behaviors Using the “p” factor in Primary Care: An Exploratory Study

Abstract

Suicide is a major, preventable public health problem. The general factor of psychopathology (“p” factor) might help improve detection and prediction of individuals at risk for suicide. This cross-sectional proof-of-concept study tests whether the p-factor score is associated with suicidal thoughts and behaviors (STB) better than a depression scale alone. Youth (N = 841; mean age 18.02, SD = 3.36) in primary care were universally screened using the Behavioral Health Screen (BHS). Factor analysis and ROC results showed the BHS assesses the p-factor, and the p-factor score demonstrates higher classification accuracy of several types of STB than a depression scale. The p-factor could help clinicians in the identification of youths with STB.

Keywords:

• Behavioral Health Screen
• p-factor
• screening
• suicide
• youth

ACKNOWLEDGEMENTS

We would like to thank Matt Wintersteen and all the families that participated in this project.

ETHICAL APPROVAL

Approval was obtained from the ethics committee of Drexel University. The procedures used in this study adhere to the tenants of the Declaration of Helsinki.

CONSENT FORM

Informed consent was obtained from all individual participants included in the study.

AUTHOR CONTRIBUTIONS

Linda Ruan-Iu, Ran Barzilay, Tyler Moore and Guy Diamond contributed to the study conception and design. Material preparation, data collection and analysis were performed by Linda Ruan-Iu, Alannah Shelby Rivers, and Tyler Moore. The first draft of the manuscript was written by Linda Ruan-Iu and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

DISCLOSURE STATEMENT

Dr. Barzilay serves on the scientific board and reports stock ownership in “Taliaz Health,” with no conflict of interest relevant to this work. Dr. Ruan-Iu, Dr. Rivers, and Dr. Moore declare they have no relevant financial or non-financial interests to disclose. Dr. Diamond created the Behavioral Health Screen while at the Children’s Hospital of Philadelphia and, thus, signed rights of the tool over to the hospital. The Hospital licenses the tool to Medical Decision Logic, Inc. When they sell the screening tool, Dr. Diamond will get a small portion of the royalty paid to the hospital. Dr. Tien is founder of Medical Decision Logic, Inc., a web technology company that has developed the BH-Works software platform and provides it commercially to education, health care, and other community settings.

AUTHOR NOTES

Linda Ruan-Iu, PhD, and Alannah Shelby Rivers, PhD, Department of Counseling and Family Therapy, College of Nursing and Health Professions, Drexel University, Pennsylvania, USA. Ran Barzilay, MD, PhD, and Tyler M. Moore, PhD, Lifespan Brian Institute, Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Pennsylvania, USA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Pennsylvania, USA. Allen Tien, MD, MHS, Medical Decision Logic, Inc, Maryland, USA. Guy Diamond, PhD, Department of Counseling and Family Therapy, College of Nursing and Health Professions, Drexel University, Pennsylvania, USA.

DATA AVAILABILITY

We report all data inclusion/exclusion criteria, whether inclusion/exclusion criteria were established prior to data analysis, all measures in the study, and all analyses including all tested models. If we use inferential tests, we report exact p values, effect sizes, and 95% confidence or credible intervals.

Additional information

Funding

This paper was in part supported by the Substance Abuse and Mental Health Services Administration’s (SAMHSA’s) SM11001 and SM060386 Garrett Lee Smith Suicide Prevention Program awarded to the Office of Mental Health and Substance Abuse in Pennsylvania and then subcontracted to Drexel University. Findings and opinions expressed in this paper do not necessarily reflect any official position of these federal or state government offices. Drs. Barzilay and Moore are supported by the National Institute of Mental Health grants K23MH120437 (RB), R21MH123916 (RB), RO1MH117014 (TMM), and the Lifespan Brain Institute of Children’s Hospital of Philadelphia and Penn Medicine, University of Pennsylvania.