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Background: Prior research has suggested that rates and acuity of suicidality are elevated among patients seen in EDs and in certain clinics. However, the occurrence and severity of suicide risk has been rarely studied in the pediatric clinic populations due in part to unsystematic screening. We examined suicidality across different pediatric clinical care settings based on data from our newly implemented hospital-wide suicide risk screening program.

Objective: To determine a) which patient populations presented with the highest rates of suicidality; and b) the percentage of patients who had current thoughts of suicide and were thus deemed “acute.”

Design/Methods: We conducted a retrospective analysis of the clinical data repository. Adolescents were screened for suicide risk between Feb 2019 and Jan 2020. Patients were eligible for suicide risk screening if they were >12 years old and had a medical visit in the inpatient (IP), emergency (ED), urgent care (UC), or outpatient (OP) clinics of a dedicated pediatric hospital in the midwest. We used the 4-question ASQ (Ask Suicide-Screening Questions) by which a positive response to any of the 4 questions was considered a positive screen. Among positives, those who gave a positive response to question 5 (“are you having thoughts of killing yourself right now?”) were classified as “acute risk.”

Results: Out of the 101,732 screenings completed during this time, 11,460 (11.3%) were positive, and 734 were at acute suicide risk. Overall positivity rates were highest among inpatients (18.6%), followed by the ED (18.0%), OP clinics (9.5%), and UC (8.8%). The highest rate of acute positives was found in the ED (3.1%), followed by IP (2.0%). The lowest rates of acute risk were observed for UC (0.2%) and OP clinics (0.1%). Among UC clinics, the highest rates of suicidality occurred in the Child Abuse Clinic (40.2%), followed by Adolescent Medicine (24.9%), Sleep and Teen Clinics (both 17.6%). The highest rate of acute suicide risk occurred in the Child Abuse Clinic (1.7%).

Conclusion(s): Suicidality among pediatric patients is highest among adolescents seen in the inpatient unit and those seen in the ED. Some pediatric outpatient clinics also have high rates of suicidality but the rate of acuity appears to be lower in this setting relative to the inpatient and ED setting. Data on the acuity of risk and on the prevalence of acute risk in different clinical settings can be used to plan for allocation of mental health resources to follow-up on positive screens.

Presented at the 2021 PAS Virtual Conference


Behavioral Medicine | Bioethics and Medical Ethics | Pediatrics

Rates of Positive Suicide Screens among the Emergency, Inpatient and Outpatient Clinics at a Tertiary Care Children’s Hospital