ANN ARBOR – Researchers at the University of Michigan have developed a universal screening tool that accurately predicts the suicide risk of a teenagers during emergency care visits.
Over the past decade, the suicide rate among adolescents in the U.S. has drastically increased. One of the greatest challenges that mental health professionals face is identifying young people who are in need of urgent help.
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In response, researchers at Michigan Medicine have developed a personalized system to be used in emergency room visits to better detect which youths may be suicidal. The tool alerts caregivers if an adolescent is at risk and whether they need follow-up interventions.
“Too many young people are dying by suicide and many at high risk go completely unrecognized and untreated,” lead author Cheryl King, a professor, clinical child psychologist and director of the Youth and Young Adult Depression and Suicide Prevention Research Program in the Department of Psychiatry at Michigan Medicine said in a statement.
“About half of the youth who die by suicide have never received any mental health services and some die on their first suicide attempt. We saw an urgent need to improve proactive, universal suicide screening of young people.”
The tool, called the Computerized Adaptive Screen for Suicidal Youth, or CASSY, is presented to patients in the form of a questionnaire on a digital device. No matter what the reason, researchers propose screening all youths using CASSY, which they say does not disrupt care.
Tailored to the individual patient, the number of questions and follow-up inquiries are based on their answers.
Questions about suicidal thoughts are peppered in with other factors such as trouble concentrating, sleep disturbance, depression, and issues with family or school. According to the researchers, their suicidal risk level is determined using a combination of risk factors.
Researchers used data from several centers that took part in the Emergency Department Screen for Teens at Risk for Suicide to develop the tool’s algorithm.
While other suicide screening tools exist, King said many high risk young people slip through the cracks, and in some cases, some adolescents rank as “false positives” for suicide risk.
“Different combinations of risk factors can place youth at risk,” King, who is also a child and adolescent psychologist at Mott Children’s Hospital said in a statement. “If we screen only for suicidal thoughts, we will miss some high risk adolescents.
“There are many reasons young people may not share suicidal thoughts, possibly because they’re ashamed, they aren’t experiencing the thoughts at the time of screening, or someone reacted in a way they didn’t feel was helpful when they shared suicidal thoughts or sensitive information in the past.”
CASSY, said King, provides emergency medicine professionals with mild to high risks with regard to the probability of a future suicide attempt.
“This screening tool has the potential to be a step forward in our effort to improve clinical care models to adequately meet the needs of youth mental health,” King said in a statement.
The computerized screening tool predicted suicide risk with 88% accuracy when tested on two cohorts of adolescents ages 12-17 who visited emergency departments. In its second cohort of 2,754 youths, 165 adolescents answered that they had made a suicide attempt over a three month period.
In the U.S., suicide is the second-leading cause of death among teens, and the suicide rate among the age group has increased by 62% since 2000.
According to King, emergency departments are an ideal setting for suicide risk screening, since roughly 19% of teens in the U.S. will visit the ED annually. Additionally, emergency departments recently reported that visits related to youth suicide risk and self-harm have doubled.
King and her colleagues hope that emergency departments across the country will consider adopting CASSy into their care models to help identify and treat teens who are at risk of suicide.
The development comes as mental health experts nationwide have sounded the alarm about the ongoing effects from the coronavirus pandemic on young people, who say continued isolation can exacerbate depression, anxiety and suicidal thoughts among those at the highest risk.