Parent and Adolescent Thoughts About Suicide Risk Screening in Pediatric Outpatient Settings

Abstract

Suicide rates among adolescents in the United States continue to climb and many at-risk youths are undetected. Screening for suicidal thoughts has become the primary approach to identify those at risk, but no studies have assessed reactions to its deployment in pediatric outpatient settings. This mixed-method study assessed parents’ and adolescents’ thoughts about suicide risk screening in non-psychiatric, pediatric outpatient specialty settings.

As part of a multi-site measurement validation study, adolescents (n = 269; ages 10–21) and parents (n = 246) at pediatric specialty clinics in the Midwest completed a survey regarding thoughts about suicide risk screening. Data were collected on tablet computers and transcribed verbatim. Three study team members independently coded transcripts of open-ended responses to identify major themes, and frequency data were analyzed using StataSE 15.1. Inter-rater agreement was substantial (Fleiss’ Kappa ranged 75–86%).

Parents (55% 41–50 years of age, 20% male, 80% White) and adolescents (Mean age = 14.3, 50% male, 77% White) agreed medical providers should screen adolescents for suicide risk (93% and 88%, respectively). Majority of parents indicated that the pediatric outpatient setting is appropriate for suicide risk screening. Major themes included the important role of providers in identifying at-risk youth, the potential for screening to prevent suicides, and concerns about iatrogenic risk and misdiagnosis.

Most parents and adolescents support screening for suicide risk in pediatric outpatient settings. Nevertheless, some have concerns about the screening process and implications. As suicide risk screening becomes standard practice in adolescent care, it’s critical to develop screening processes that maximize comfort and address concerns.

Keywords:

• Adolescent
• outpatient settings
• parent
• suicide screening

DISCLOSURE STATEMENT

The authors have no conflicts of interest to report.

AUTHOR NOTES

Andrea Bradley-Ewing, Division of Health Services and Outcomes Research, Children's Mercy Kansas City, Kansas City, MO, USA.

Shayla A. Sullivant, Division of Developmental and Behavioral Sciences, Children's Mercy Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.

David D. Williams, Division of Health Services and Outcomes Research, Children's Mercy Kansas City, Kansas City, MO, USA.

Elizabeth Lanzillo, Department of Psychology, Brown University, Providence, RI, USA.

Laika Aguinaldo, School of Health Sciences, University of California-San Diego, San Diego, CA, USA.

Elizabeth Wharff, Department of Psychiatry, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA.

Lisa M. Horowitz, Office of the Clinical Director, National Institutes of Mental Health, Bethesda, MD, USA.

Kathy Goggin, Division of Health Services and Outcomes Research, Children’s Mercy Kansas City, University of Missouri–Kansas City Schools of Medicine and Pharmacy, Kansas City, MO, USA.

Additional information

Funding

This research was supported in part by Children’s Mercy Kansas City Institutional Funding (2017-2018), Children’s Mercy Kansas City Department of Social Work, and the Intramural Research Program of the NIMH (Annual Report Number ZIAMH002922).