Running Head: PEDIATRIC SUICIDE SCREENING IN ER 1

Pediatric Specific Suicide Screenings in the Emergency Room:

A Literature Review

Nicky Reed

Ferris State University

PEDIATRIC SUICIDE SCREENINGS IN THE ER 2

Abstract

Behavioral health concerns are at the forefront of awareness with adolescent and teen suicide

becoming the highlight. With growing social media, adolescents and teens are becoming more

vulnerable to peer pressures and cyber bullying. Many children are seen in emergency rooms

each year making it an ideal environment for screening pediatric populations with age

appropriate tools to identifying those at risk for suicide. Existing adolescent suicide screening

tools are valuable tools in screening pediatric populations that do not present with psychological

complaints. The time is now to implement an action plan for identifying at risk youth across the

nation. Self-reporting alone is not the answer to identifying the vulnerable adolescent

population. Pediatric specific suicide screening tools are quick, efficient, and accurate tools at

identifying adolescents and teens that present without non-psychiatric complaints within the

emergency department.
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Pediatric Specific Suicide Screening in the Emergency Department

Pediatric suicide has been a growing concern across the nation. Adolescent and teens are

challenged with the normal challenges in life that are exploited through social media. The

Center for Disease Control and Prevention (2014) published that within the age group of 10 and

24 years old, suicide is the second leading cause of death. The purpose of this paper is to review

previous studies that address whether pediatric populations within the emergency department

setting screened with pediatric specific suicide tools compared to standard adult screening tools

provide better opportunity to detect pediatric patients at risk for self-harm?

The search engine utilized for the review was the Ferris State University Flite Library.

The databases that were included in the search were Exlibris, Springer Standard Collection,

Medline/PubMed, Oxford Journals, ProQuest Psychology Journals, SAGE journals, and Wiley

Online. The key words searched included pediatric, adolescent, suicide screening, and

emergency department. The search criteria were then further filtered to provide only peer-

reviewed articles over the last six years. The studies that were selected had to include all

searched terms to provide an accurate review of literature. Furthermore, the studies were

assessed for validity, creditability and reliability by examining the researcher’s credentials, if the

studies could be reproduced, and whether there were any conflicts of interest. The first step in

the literature review was identifying key adolescent and teen screening tools as acknowledged by

Babeva, Hughes, and Asarnow.

Babeva, Hughes, and Asarnow (2016) reviewed the effectiveness of available screening

tools and strategies within the emergency department among youth populations. The study was

conducted utilizing available suicide screening tools such as Ask Suicide Screening Questions

(ASK) followed by the more comprehensive Suicidal Ideation Questionnaire (SIQ), Columbia-
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Suicide Severity Rating Scale (C-SSRS) and Suicidal Ideation Questionnaire-Junior (SIQ-J)

(Babeva, Hughes, & Asarnow, 2016). Babeva, Hughes and Asarnow (2016) found that youth are

more likely to report utilizing a self-report questionnaire versus an oral performed method in

front of parents. Furthermore, the review found that computerized assessment tests such as

Suicide Implicit Associations Test (S-IAT) provided a successful capture of youth that had been

thinking about committing suicide but did not verbalize the thoughts (Babeva, Hughes, Asarnow,

2016). Overall, the study established the importance of pediatric suicidal screenings in the

emergency room(ER) setting as a crucial importance to improving pediatric outcomes, decrease

visits to the ER, and prevention of suicide. Limitations to this study was that even though

studies were reviewed, no studies were implemented by the researchers. Babeva, Hughs, and

Asarnow provided a review of all available suicide screening tools and categorized each into

measureable ranges that included number of items, whom could administer the screening, age

range, scoring system, length of administration time, and whether it was free or cost money

(2016). To further investigate the use of pediatric specific screening tools other specific tools

were thoroughly analyzed.

Ballard, Cwik, Van Eck, Goldstein, Alfes, Wilson, Virden, Horowitz, and Wilcox (2016)

examined the use of the Ask Suicide Screening Questions (ASQ) within a pediatric emergency

department and its ability to identify pediatrics at risk for suicide. The emergency department

setting is a vital environment to identify and intervene in suicide risk for the pediatric population

that present to the emergency room setting without complaints of suicide. Ballard et al. (2016)

found that the ASQ was a valuable tool for identifying at risk adolescents and teens. With a

compliance rate of 79% by triage nurses, 53% of adolescents and teens screened positive that

originally did not present to the emergency department with a suicide-related complaint (Ballard
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et al., 2016). Limitations to this study were the singular emergency department site and the

potential effects of parents being present during examine questions are a bias related to accuracy

of answers. Comparatively, a study conducted by King, O’Mara, Hayward, and Cunningham

obtained related results.

King, O’Mara, Hayward, and Cunningham (2009) examined the validity and use of

adolescent suicide screening tools within the emergency department and the positive results

using two different tools. The study found that 16% of adolescents screened positive that

presented with non-psychiatric complaints and the screenings were valid and reliable (King,

O’Mara, Hayward, & Cunningham, 2009). It is well known that adolescent males are less likely

to report creating constraints to identifying this high-risk population. The study identifies a

positive ability to capture those with higher success of suicide by intervening in the emergency

department setting (King, O’Mara, Hayward, & Cunningham, 2009). Limitations to this study

were the single site used for the study and that the sample size was predominately Caucasian

which limited generalizability. Another type of screening is addressed in further in the following

study.

Capelli, Gray, Zemek, Cloutier, Kennedy, Glennie, Doucet, and Lyons (2012) developed

a rapid standardized suicide screening tool for the pediatric population within the emergency

department setting called HEADS-ED. The study conducted an analysis of the HEADS-ED tool

within the emergency department for youth populations. Capelli et al. (2012) examined whether

the tool was valid and reliable to identifying at risk pediatric populations. The findings

concluded that the HEADS-ED tool provided promising decision making opportunity for

pediatric populations (Capelli et al., 2012). The HEADS-ED predicted pediatric psych

admission to inpatient units at an 87% rate (Capelli et al., 2012). Limitations of this study were
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that only one suicide screening tool was assessed and the study was limited to one emergency

department.

Pediatric specific suicide screening tools in the emergency department setting are

valuable at identifying at risk adolescents and teens. Emergency departments are the front line of

healthcare that see many youth every year. The accessibility makes the emergency department

the ideal setting to identify adolescents and teens at risk and intervene with appropriate

measures. As reviewed with multiple studies, different screening tools are available for the

adolescent and teen population.

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References

Ballard, E. D., Cwik, M., Van Eck, K., Goldstein, M., Alfes, C., Wilson, M. E., Virden, J. M.,

Horowitz, L. M., & Wilcox, H. C. (2016). Identification of at-risk youth by suicide

screening in a a pediatric emergency department. Prevention Science, 18(1), 174-182.

doi:10.1007/s11121-016-0717-5

Babeva, K., Hughes, J. L., & Asarnow, J. (2016). Emergency department screening for suicide

and mental health risk. Current Psychiatry Rep, 18(1), 100-112. doi:10.1007/s11920-

016-0738-6

Cappelli, M., Gray, C., Zemek, R., Cloutier, P., Kennedy, A., Glennie, E., Doucet, G., & Lyons,

J. S. (2012). The heads-ed: A rapid mental health screening tool for pediatric patients in

the emergency department. Pediatric, 130(2), 321-327. doi:10.1542/peds.2011-3798

The Centers for Disease Control and Prevention (2014). 10 leading causes of death by age

group, in the United States. Retrieved from https://www.cdc.gov/injury/images/lc-

charts/leading_causes_of_death_age_group_2014_1050w760h.gif

King, C. A., O’Mara, R. M., Hayward, C. N., & Cunningham, R. M. (2009). Adolescent suicide

risk screening in the emergency department. Society for Academic Emergency Medicine,

16(11), 1234-1241. doi:10.1111/j.1553-2712.2009.00500.x