In teens with a positive suicide screen, recent attempts and hopelessness marked higher risk of a later attempt

Design

Secondary analysis of a prospective multicentre ED cohort (PECARN)

Population

2,085 adolescents aged 12 to 17 with a positive Ask Suicide-Screening Questions result

Primary outcome

Suicide attempt within 3 months

Effect

11.6% attempted; past-month attempt aOR 2.52 (95% CI 1.84 to 3.45); hopelessness aOR 1.30 (1.04 to 1.63)

This secondary analysis used a prospective cohort of 2,085 adolescents aged 12 to 17 who screened positive on the Ask Suicide-Screening Questions in US emergency departments between 2015 and 2019. About two-thirds were female. Within three months, 11.6% attempted suicide and 19.9% had a mental-health-related ED revisit or hospitalisation.

Factors associated with a later attempt were a suicide attempt in the past month (adjusted odds ratio 2.52, 95% CI 1.84 to 3.45), past non-suicidal self-injury (2.06, 1.41 to 3.01), prior mental health hospitalisation (1.39, 1.02 to 1.90) and hopelessness (1.30, 1.04 to 1.63). For revisit or hospitalisation, prior mental health hospitalisation (2.23) and recent attempt (1.63) and hopelessness (1.44) stood out.

These are associations in a US cohort that screened positive, so they help with risk assessment after a positive screen but do not identify who will attempt suicide. The authors say the factors may be worth considering when deciding next steps. The study cannot say whether acting on them changes outcomes.

• After a positive screen, ask about attempts in the past month, self-injury, previous psychiatric admission and hopelessness.
• About one in nine screen-positive teens attempted suicide within three months.
• No single factor identifies who will attempt; use them to inform, not replace, clinical assessment.
• Make sure a follow-up plan exists before the teenager leaves the department.

Why it matters

A positive screen starts the assessment; these factors help decide how much follow-up it needs.

Don't overread it

These are associations from a US cohort and are not a validated tool for deciding who to admit.

The statistics, in plain English

An adjusted odds ratio of 2.52 means the odds of an attempt were about two and a half times higher in those with a past-month attempt than in those without, after accounting for the other factors. It is not a prediction rule for one patient.

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