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Personalized Screen to ID Suicidal Teens in 14 ERs

Aimed to Help Front-line Clinicians Save Lives

Science Update

Emergency Department Screen for Teens at Risk for Suicide  (ED-STARS), a recently-launched study in a network of hospital emergency departments (EDs) across the country, will develop and test a personalized, computer-based suicide risk screening tool for teenagers.

Hospital emergency department entrance“We plan to refine algorithms capable of predicting which youth are most likely to attempt suicide. We will use these to develop a brief and personalized screening tool in which each question presented to a teen is based on the individual’s previous responses” explained Cheryl King, Ph.D., of the University of Michigan, principal investigator on the NIMH-funded project, along with David Brent, M.D. , of University of Pittsburgh Medical Center, and Jacqueline Grupp-Phelan, MD, MPH  of the Cincinnati Children’s Hospital Medical Center. “After it’s validated, this screen will be made available to emergency departments nationwide as an ED- and patient-friendly tool for screening, risk stratification and triage.”

Suicide is the second leading cause of death among teens aged 12-17, accounting for about 1,000 deaths in 2011 . A 2013 survey  indicated that as many as 2.7 percent of high school students nationwide made a suicide attempt resulting in injury or overdose requiring medical attention in the past year. The same survey also found that 8 percent of students reported having made at least one suicide attempt in the past year, and 13.6 percent reported having a plan for how they would kill themselves.

NIMH has focused on hospital emergency departments as a prime setting for suicide prevention efforts in recent years. In 2009 there were approximately 9.8 million ED visits for youth ages 10-17, including about 700,000 involving a psychiatric concern, and about 128,000 for intentional self-harm . After funding the ED-SAFE study for suicide prevention in adults in 2009, NIMH, together with NIDA and NIAAA, began laying the groundwork for a similar project targeting youth. A 2013 NIMH funding opportunity announcement, Pediatric Suicide Prevention in ED Settings , sought to improve evidence-based ED practices for detecting and referring at-risk youth. The ED-STARS effort was funded in response to this request.

ED-STARS involves a collaboration between researchers and the Pediatric Emergency Care Applied Research Network  (PECARN), and the Whiteriver PHS Indian Hospital . The 14 participating emergency departments serve geographically and socially diverse populations, including American Indian youth, who are at particularly high risk for suicide.

In the project’s first study, over 6,000 youth will be screened, and researchers will follow up on a subsample of 12-17 year-olds who score high on suicide risk factors – as well as those who score low. Their experiences over a 6-month period will be used to develop a computerized adaptive screen (CAS) for predicting suicide attempts that adjusts its line of questioning depending on responses to previous questions. The researchers will then compare the sensitivity, specificity, and predictive value of the CAS with the Ask Suicide-Screening Questions (ASQ), a standardized ED youth suicide prevention screening tool, developed by Lisa Horowitz, Ph.D., M.P.H., of the NIMH Intramural Research Program.

A second study will validate the CAS and associated risk stratification algorithm, determining the measure’s ability to predict suicide attempts in a new sample of over 2,000 youth. The potential benefit of including a behavioral test of suicidal thoughts, the Implicit Association Test (IAT), as part of the screening process will also be evaluated.

“We’re excited about the promise of what ED-STARS can deliver,” said Amy Goldstein Ph.D, NIMH Associate Director of Prevention Research, and Chief of the Child and Adolescent Preventive Intervention Program, which funds the study. “It will provide ED clinicians nationwide with an easy-to-administer screening instrument that classifies youth as high, moderate or low-risk, enabling efficient triaging of resources and identification of modifiable risk factors for treatment – a tool that can save lives.”