Design: Secondary analysis of a prospective multicentre cohort
Population: 2,085 adolescents aged 12–17 with a positive ASQ screen in US EDs
Primary outcome: Suicide attempt within 3 months
Effect: 11.6% attempted; recent attempt aOR 2.52 (95% CI 1.84–3.45)

This secondary analysis of a prospective PECARN cohort included 2,085 adolescents aged 12–17 who screened positive on the Ask Suicide-Screening Questions (ASQ) in US emergency departments between 2015 and 2019.

Within three months, 11.6% attempted suicide and 19.9% returned to the ED or were admitted for mental health reasons. After adjustment, a suicide attempt in the past month (aOR 2.52, 95% CI 1.84–3.45), prior non-suicidal self-injury (aOR 2.06, 1.41–3.01), prior mental health admission (aOR 1.39, 1.02–1.90) and hopelessness (aOR 1.30, 1.04–1.63) were each associated with a later attempt.

A positive screen is the start of an assessment, not its end. These four features — recent attempt, self-harm history, previous admission, hopelessness — are quick to ask and identify the adolescents who need the most intensive follow-up, safety planning and means restriction before they leave.

Ask every adolescent who screens positive about a suicide attempt in the past month.
Ask about past self-harm without suicidal intent — it doubled the odds of a later attempt.
Ask directly about hopelessness and previous psychiatric admission.
Complete a safety plan and counsel families on restricting access to means, including medicines and pesticides, before discharge.
Arrange mental health follow-up within days, not weeks, for those with these risk factors.

Why it matters

It turns a positive screen into a short, targeted risk assessment that shapes discharge planning.

The statistics, in plain English

An adjusted odds ratio of 2.52 means the odds of a later attempt were about two and a half times higher in those with a recent attempt, after accounting for other factors. These are associations in a US cohort; they help prioritise, but no single factor predicts an individual's risk well.