Suicide Risk in Children and Adolescents in a Pediatric Emergency Department: Effects of Race, Income, Gender, and Age
Suicide in adolescents is a leading cause of death and a public health concern. Suicide screening in the pediatric emergency department (ED) has emerged as a promising method of suicide prevention, as this setting treats many at-risk children and adolescents and has potential resources to manage positive screens. While suicide screening tools exist, they have not been validated on diverse samples, particularly in minority and lower-income populations. Additionally, clinical and demographic suicide risk factors that are specific to diverse, lower-income ED populations have not been identified. For the purposes of this study, a retrospective medical record analysis was conducted to evaluate the utility of a suicide screening tool in a predominately African American, low-income population. Specifically, responses to the Risk of Suicide Questionnaire (RSQ), a suicide screening tool developed to evaluate patients presenting to the pediatric ED for psychiatric reasons, were evaluated against other demographic, clinical and administrative variables. The study also aimed to identify clinical and demographic factors related to suicide risk to facilitate the development of targeted interventions. From a logistic regression analysis of 493 patient visits to an urban pediatric ED over a nine-month period, a positive score on the RSQ was associated with increased odds of psychiatric hospitalization. RSQ score was not associated with foster care or insurance status. Female gender was associated with suicide risk; however, given a depression diagnosis, there was no difference in suicide risk between the genders. There was no association between a history of violent behavior and suicide risk. While there was no direct relationship between abuse and suicide risk, using multiple regression, there was an interaction between age and abuse history with older adolescents demonstrating a stronger relationship between abuse and suicide risk. Overall, a suicide screening tool can predict hospitalization and may identify children and adolescents in most need of psychiatric resources in a pediatric ED. Potential targets for intervention include suicidal behavior, depression diagnosis and trauma, particularly for older adolescents. Implications for assessment and intervention in pediatric EDs are discussed.
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