Which screen-positive youth are at highest suicide risk?

Design

Secondary analysis of a prospective multicentre ED cohort

Population

2,085 adolescents aged 12 to 17 with a positive suicide screen

Primary outcome

Suicide attempt and mental-health revisit within three months

Effect

11.6% attempted; recent attempt adjusted odds ratio 2.52 (95% CI 1.84-3.45)

A positive suicide screen in the emergency department raises the question of who needs the most intensive response. This secondary analysis of a research-network cohort followed 2,085 adolescents aged 12 to 17 with a positive Ask Suicide-Screening Questions result.

The outcomes were sobering: 11.6% attempted suicide and 19.9% had a mental-health-related revisit or hospitalisation within three months. Four factors marked higher risk of a subsequent attempt: a suicide attempt in the past month (adjusted odds ratio 2.52), past non-suicidal self-injury (2.06), prior mental-health hospitalisation (1.39) and hopelessness (1.30). Similar factors predicted revisit or hospitalisation.

The practical use is in disposition. After a positive screen, a recent attempt, past self-injury, prior psychiatric admission or expressed hopelessness should weigh towards more intensive assessment and follow-up, rather than treating all screen-positive adolescents identically.

• Cohort of 2,085 adolescents aged 12 to 17 with a positive ED suicide screen.
• 11.6% attempted suicide and 19.9% had a mental-health revisit or admission within three months.
• A suicide attempt in the past month carried the highest risk (adjusted odds ratio 2.52).
• Past non-suicidal self-injury (2.06) and hopelessness (1.30) also marked higher risk.
• Use these factors to weight disposition after a positive screen.

Why it matters

It helps separate the screen-positive adolescents who most need intensive follow-up from those at lower short-term risk.

Don't overread it

These are risk associations, not a validated prediction tool; the absence of a listed factor does not make a screen-positive adolescent safe.

The statistics, in plain English

An adjusted odds ratio of 2.52 means roughly 2.5 times the odds of a subsequent attempt, but with 11.6% attempting overall, even lower-risk screen-positive youth have a substantial absolute risk. The factors sharpen, rather than replace, clinical judgement.

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