One in nine adolescents with a positive ED suicide screen attempted within three months

Design

Secondary analysis of a prospective multicentre cohort

Population

2,085 adolescents aged 12–17 with a positive ASQ screen in US emergency departments

Primary outcome

Suicide attempt within 3 months of the index visit

Effect

11.6% attempted; recent attempt aOR 2.52 (1.84–3.45), self-harm aOR 2.06 (1.41–3.01)

This secondary analysis used a prospective cohort from the US Pediatric Emergency Care Applied Research Network, including 2,085 adolescents aged 12 to 17 who screened positive on the Ask Suicide-Screening Questions in the emergency department between 2015 and 2019.

Within three months, 11.6% attempted suicide and 19.9% returned to the emergency department or were admitted for a mental health reason. An attempt in the past month (adjusted OR 2.52), past non-suicidal self-injury (2.06), a previous psychiatric admission (1.39) and hopelessness (1.30) were associated with a later attempt.

A positive screen is common and most adolescents who screen positive will not attempt, but the three months after the visit are a window of real risk. The identified factors are things an emergency clinician can ask about in a few minutes, and they help decide who needs the most urgent follow-up. This is an association study in a US network; the factors guide, but do not replace, a full assessment.

• Ask every adolescent with a positive suicide screen about attempts in the past month and about self-harm.
• Ask directly about hopelessness and previous psychiatric admissions.
• Arrange early follow-up after discharge, since risk remains high for the following three months.
• Counsel families on restricting access to means, including medicines and pesticides at home.

Why it matters

Discharge after a positive screen opens three months of substantial risk, not the end of it.

Don't overread it

The factors predict risk in a group; they cannot rule out an attempt in any individual.

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 with a recent attempt, after accounting for other factors. These are associations, so they mark risk rather than explain it.

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