Screening as an Approach for Adolescent Suicide Prevention
Among the provisions of the recently signed Garrett Lee Smith Memorial Act, Congress called for the use of screening to detect adolescents who are at risk for suicide. After a review of the literature, 17 studies involving screening instruments and programs were identified. We addressed the question: What do we know about the demonstrated effectiveness and safety of screening as a tool or program to prevent suicide among adolescents? While youth suicide screening programs offer the promise of improving identification for those who need treatment the most, further research is essential to understand how, when, where, and for whom screening programs can be used effectively and efficiently.
Available from: Kelly Posner
- "Using a scale with stratified thresholds in conjunction with triage protocols may enable the reduction of burden on limited mental health services and the subsequent redirection of scarce resources (Peñta & Caine, 2006). "
Available from: Stephan Collishaw
- "Second, there may be worries about the acceptability and potential iatrogenic effects of the use of questionnaires that focus only on suicidal ideation in unselected general population samples, either for research or for screening purposes (Peña and Caine, 2006). Third, diverse screening tools for suicide-related ideation exist, and most are designed specifically for use as screening tools in the context of suicide prevention programs. "
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ABSTRACT: The Mood and Feelings Questionnaire (MFQ) is widely used for the assessment of depression in adolescents. The main aim of this study was to examine the concurrent and predictive validity of a composite of four MFQ items related to suicidal ideation using an interview measure of suicidal ideation. A prospective 3-wave high-risk study of offspring of parents with recurrent depression was used including 294 families where children were initially aged 9–17 years. Measures included four parent and child rated MFQ items assessing suicide-related ideation (referred to here as the “MFQ-SI”) and a clinically-defined interview measure of suicidal ideation. A parent-child combined MFQ-SI subscale performed well as a screening tool against the interview measure of suicidal ideation (baseline AUC (95% CI):0.92 (0.85–1.00)). Longitudinally, this measure showed reasonable predictive validity against future suicidal ideation (AUC (95% CI):0.73 (0.58–0.88)). Lastly, there was evidence that a child-rated MFQ-SI scale performed better than a parent-rated one in detecting concurrent suicidal ideation. Longitudinally, both parent and child scales showed reasonable predictive validity against future suicidal ideation. In summary, a brief screen using four MFQ items related to suicidal ideation performs well in identifying concurrent and future suicidal ideation in high-risk adolescents.
- "Estimating their suicide risk is particularly diffi cult because conventional risk factors like depression are too common among alcoholic inpatients to provide predictive validity (Peña and Caine, 2006; Wagner et al., 2004). Hence, there is the need to identify novel predictors like childhood adversities . "
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Alcohol dependence is frequently associated with suicide attempts. A history of adverse childhood experiences (ACEs) increases the risk of emotional and behavioral problems in adulthood. Child abuse is reported to increase suicide risk among alcohol-dependent patients. However, other types of ACEs, including ACEs related to family dysfunction that may have exceptional impact among the Chinese, are rarely explored.
The contribution of a broad spectrum of ACEs to lifetime risk of suicide attempts among alcoholic inpatients in Taiwan was examined. Family Health History Questionnaires were used to assess ACEs among 194 male alcohol-dependent inpatients admitted for alcohol detoxification. Logistic regression analysis was applied to examine the prediction of ACEs for lifetime risk of suicide attempts.
The rate of attempted suicide in this cohort was 27.4%. The prevalence of ACEs was high, with around 90% of participants reporting at least one type of ACE. In the regression analysis, after adjusting for lifetime depression, illicit drug use, and severity of alcohol dependence, having had a battered mother (odds ratio [OR] = 3.99, 95% CI [1.40, 11.34]) and having parents who were separated/divorced (OR = 7.35, 95% CI [1.56, 34.72]) were associated with the risk of suicide attempts, but having experienced physical and sexual abuse were not. A 1-unit increase in childhood adversity raised the likelihood of a suicide attempt by 61% (OR = 1.61, 95% CI [1.16, 2.25]).
There is a direct and graded relationship between childhood adversities and lifetime risk of suicide attempts among male alcoholic patients. In Chinese societies, adversities related to parental separation, divorce, and interparental violence may have a specific effect in aggravating suicide risk.
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