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Using Behavioral Measures to Assess Suicide Risk in the Psychiatric Emergency Department for Youth

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Abstract

Suicide screening is critical in pediatric emergency departments (EDs). Behavioral measures of suicide risk may complement self-report measures. The current study examines suicide-specific behavioral measures and tests their potential short-term within-person effects among respondents, ability to discriminate future suicide attempt from suicidal ideation, and translation into interpretable categorical composite scores. The sample included 167 youth (10–17 years), presenting for suicide-related reasons to a pediatric psychiatric ED. During their ED visit, participants completed the Death/Life Implicit Association Test (IAT) and the Suicide Stroop Task. Recurrent suicidal thoughts and attempts were assessed within 6 months of the ED visit via medical records and email surveys. Youth displayed a decrease in the levels of distress and self-injurious desires (negative mood, desire to hurt themselves, and desire to die) after completing the behavioral tasks. The Death/Life IAT prospectively differentiated with 68% accuracy between youth who attempted suicide after their ED visit and those who had suicidal ideation but no attempt, p = 0.04, OR = 5.65, although this effect became marginally significant after controlling for self-report and demographic covariates. Neither the Suicide Stroop Task, nor the categorical composite scores predicted suicide attempts, ps = 0.08–0.87, ORs = 0.96–3.95. Behavioral measures of suicide risk administered in the ED do not appear to increase distress or self-injurious desires. They may be able to distinguish those who go on to attempt suicide (vs. consider suicide) within six months after discharge.

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Data Availability

Participant consent to data sharing in a public repository or upon request was not obtained for this research, so supporting data are not available.

Notes

  1. Because several demographic and self-report covariates predicted the 6-month outcomes at the level of p < .10, we ran supplemental analyses while including a broader range of covariates (age, gender, sexual orientation, HSC total score, lifetime suicide attempt presence, autism spectrum disorder diagnosis, and patient prediction of a future suicide attempt). The distinction between the suicide attempt group and the suicidal ideation-only group stayed marginally significant, p = .06, aOR = 6.64, 95% CI [0.94, 46.68]. Covariates did not have significant effects, ps = .08-.99. Relative to the univariate model, adding the demographic and self-report measure covariates did not significantly improve prediction accuracy, AUC = .74, 95% CI = [.62, .86].

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Funding

This study was supported by the Young Investigator Grant from the American Foundation for Suicide Prevention (YIG-2–026-16, PI: Cha).

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Authors and Affiliations

  1. Department of Behavioral Sciences, Long Island University, Post Campus, Brookville, NY, USA

    Ki Eun Shin

  2. Department of Child and Adolescent Psychiatry, New York University Grossman School of Medicine, New York, NY, USA

    Argelinda Baroni & Ruth S. Gerson

  3. Department of Psychology, University of Notre Dame, Notre Dame, IN, USA

    Kerri-Anne Bell

  4. Department of Psychology and Neuroscience, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Olivia H. Pollak

  5. Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA

    Katherine Tezanos & Anthony Spirito

  6. Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, NY, USA

    Christine B. Cha

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Contributions

Conceptualization: CBC, AB, RSG; Methodology: CBC, AB, RSG, KB, OHP, KT, KS; Formal analysis and investigation: KS, OHP, KB; Writing—original draft preparation: KS, KB; Writing—review and editing: CBC, AB, RSG, OHP, KT, AS; Funding acquisition: CBC; Resources: CBC, AB, RSG; Supervision: AS.

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Correspondence to Christine B. Cha.

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Shin, K.E., Baroni, A., Gerson, R.S. et al. Using Behavioral Measures to Assess Suicide Risk in the Psychiatric Emergency Department for Youth. Child Psychiatry Hum Dev (2023). https://doi.org/10.1007/s10578-023-01507-y

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