Suicide is the second-leading cause of death in adolescents and young adults ages 10-24 in the United States. The 6,500 deaths each year account for 14% of all suicides nationwide. To help address this urgent public health crisis, the American Academy of Pediatrics (AAP) on March 2 issued new recommendations that call for pediatric health providers to screen all young people age 12 and older for suicide risk at least once a year.
Research shows that many young people who die by suicide interact with the health care system in the weeks or months before their death. In one study, 38% of individuals up to age 19 who died by suicide had seen a health care provider within four weeks of their deaths. Still, fewer than half the people in that group received a mental health diagnosis at the time of their visit.
Adolescence can be a challenging time of social, emotional, and physical development. Today, the stress from the COVID-19 pandemic has exacerbated these challenges for millions of children and young adults nationwide. Compared with the same time period in 2019, emergency department visits for suspected suicide attempts among 12-to-17-year-old U.S. females were 51% higher in early 2021.
But health care visits can serve as a critical intervention point to identify those at risk for suicide so they can be further assessed before reaching a crisis point. Universal suicide screening can help pediatricians and other pediatric health providers better identify such patients.
The AAP and the American Foundation for Suicide Prevention’s (AFSP’s) recent publication, Blueprint for Youth Suicide Prevention, includes AAP’s new recommendations for universal screening for adolescents and young adults age 12 and older. Universal screening is the practice of screening all patients for suicide risk, not just those who have a behavioral health concern or diagnosis.
Data suggests that young people do not always disclose thoughts about suicide or suicidal behavior on their own. Further, while youth of all races, ethnicities, ages, gender identities, sexual orientations, socioeconomic statuses, and communities experience suicide risk, research shows inequities in suicide rates, risk, and care. Some of those most at risk for suicide include American Indian and sexual and gender minority populations. Universal screening is one strategy within broader suicide prevention initiatives that can promote inclusive and equitable care; it also helps to ensure that specific and standardized questions are asked of all youth.
Validated, evidence-based screening tools for pediatric populations exist that effectively and rapidly identify patients at risk for suicide. Screening typically takes less than a minute to complete and can be seamlessly included with other health intake questions. Patients who screen positive for suicide risk then should receive a brief safety assessment to determine if more in-depth evaluations are required.
In addition to universal screening, AAP and AFSP highlight numerous clinical and community strategies that pediatric health providers can implement as part of comprehensive suicide prevention and care for youth. The strategies include building partnerships with community behavioral health providers to ensure easy referral processes for youth who require further assessments or treatment and establishing culturally competent clinic environments and prevention programs to support youth across cultures and populations.
Allison Corr works on Pew’s suicide risk reduction project.