Could asking teens a simple, but pointed, question about their mental health reveal whether they are at risk for suicide?
It might, new research suggests.
Since suicide is now the second leading cause of death among American teens, any strategy that could lower that risk may be worth trying.
“The depression screening tool we used is not a suicide risk assessment tool, but it does include one question that asks [students] about thoughts of self-harm,” explained study lead author Dr. Deepa Sekhar, an associate professor in the department of pediatrics at Penn State College of Medicine.
The question is: “How often have you been bothered by… thoughts that you would be better off dead or of hurting yourself in some way?”
Compared with those teens who were not asked that question, those who were “were seven times more likely to be identified at-risk for suicide, and four times as likely to initiate treatment,” Sekhar noted.
To assess the potential benefit of asking teens about suicidal thoughts, the researchers worked with students at 14 Pennsylvania high schools. About 46% of the nearly 13,000 students in the study were girls, and 43% were Black or Hispanic.
The researchers used a standardized health questionnaire. Its main goal was to screen for symptoms of major depression disorder. It comprised nine questions, the last of which touches on suicide and self-harm.
In prior work, investigators had determined that administering the questionnaire to all students was a better way to identify depression risk, rather than relying on referrals of at-risk students on the basis of bad academics or behavior issues.
But by including question 9, school administrators were faced with the task of referring any and all students pegged as at-risk for suicide for immediate same-day counseling assistance, as required by state law.
In some cases, that burden proved difficult to manage, and "some of the schools asked if it was possible to conduct the depression screening without item No. 9," Sekhar explained.
So, she and her colleagues wanted to see if keeping question 9 made a difference.
Half the enrolled schools administered all nine questions to 9th and 11th graders, while only eight questions were asked of 10th and 12th graders. The remaining schools flipped the script, offering all nine questions, including the one on suicide and self-harm, to 10thand 12th graders.
Among the findings: Those who were asked question 9 were almost eight times more likely to get their mental health care needs quickly met.
And “the real benefit was that screening led to [fast] treatment initiation," Sekhar added.
She noted that the eight-question version missed about 30% of those teens who would have been pegged as being at risk for suicide had they been asked question 9.
Sekhar stressed that even the full nine-question version is not intended to be a full screening for suicide. But the findings suggest that including a question that addresses suicide does seem to make a difference, and any future effort to formulate “a suicide-specific risk assessment would have even greater impact on treatment initiation for identified youth," she said.
Sekhar and her colleagues recently published their work in The Journal of Pediatrics.
Two outside experts celebrated the initiative.
Sarah Coyne is associate director with the School of Family Life at Brigham Young University in Utah. She's unsure how many schools have implemented or are considering implementing a similar effort.
Still, Coyne said, “I think this is a great idea. Anything we can do to identity youth that are struggling with their mental health and then to offer early intervention will save lives."
Dr. Alecia Vogel-Hammen, an assistant professor of psychiatry at Washington University's School of Medicine in St. Louis, found the findings “really promising.”
"I personally have taken care of children who went to their school counselors after school-wide presentations about depression and suicidal thoughts,” she noted. "Some of those children say they didn't realize this was something others experienced also and that people could help until they talked about it in school."
As for parental concerns that broaching the topic might put ideas in a teen's head, Vogel-Hammen said, "That's not what studies show. Instead, it really does help identify kids who are already having those thoughts, and doesn't cause those thoughts in people who are not.”
The real concern, she said, is whether or not there's enough assistance to address those kids who need help, given that “there is a really high need for mental health services and not always enough therapists, physicians and other service providers."
"We need to make sure we're investing in those services and making them accessible to everyone, in addition to improving our screening," Vogel-Hammen said.
There's more on youth and suicide at the U.S. Centers for Disease Control and Prevention.
SOURCES: Deepa Sekhar, MD, MSc, associate professor, department of pediatrics, Penn State College of Medicine, Hershey, Pa.; Sarah Coyne, PhD, professor and associate director, School of Family Life, Brigham Young University, Provo, Utah; Alecia Vogel-Hammen, MD, PhD, assistant professor and assistant fellowship director, research, Department of Psychiatry, Washington University School of Medicine in St. Louis; The Journal of Pediatrics, December 2022