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==Overview==
==Overview==
The United States Preventive Services Task Force (USPSTF) have declared that there is insufficient evidence to determine the benefits of screening for suicide risk in the general population of United States adolescents having no prioe history of mental disorders or previous suicide attempts.


==Screening==
==Screening==


The United States Preventive Services Task Force (USPSTF) have declared that there is insufficient evidence to determine the benefits of screening for suicide risk in the general population of United States adolescents having no prioe history of mental disorders or previous suicide attempts.
The United States Preventive Services Task Force (USPSTF) have declared that there is insufficient evidence to determine the benefits of screening for suicide risk in the general population of United States adolescents having no prioe history of mental disorders or previous suicide attempts.<ref name="pmid27354459">{{cite journal |vauthors=Shain B |title=Suicide and Suicide Attempts in Adolescents |journal=Pediatrics |volume=138 |issue=1 |pages= |date=July 2016 |pmid=27354459 |doi=10.1542/peds.2016-1420 |url=}}</ref>


'''Primary care'''  
'''Primary care'''  
*Direct questioning: Screening adolescents for suicidal ideation by directly asking about it in the context of screening for depression (Practice guidelines from the American Academy of Pediatrics)  
*Direct questioning: Screening adolescents for suicidal ideation by directly asking about it in the context of screening for depression (Practice guidelines from the American Academy of Pediatrics)  
*Patient Health Questionnaire (PHQ-9): A self-report screening tool, such as the nine-item Patient Health Questionnaire (PHQ-9) modified for teens, which screens for depression and as such, includes one item that asks about suicidal ideation.  
*Patient Health Questionnaire (PHQ-9): A self-report screening tool, such as the nine-item Patient Health Questionnaire (PHQ-9) modified for teens, which screens for depression and as such, includes one item that asks about suicidal ideation<ref name="pmid23609101">{{cite journal |vauthors=O'Connor E, Gaynes BN, Burda BU, Soh C, Whitlock EP |title=Screening for and treatment of suicide risk relevant to primary care: a systematic review for the U.S. Preventive Services Task Force |journal=Ann. Intern. Med. |volume=158 |issue=10 |pages=741–54 |date=May 2013 |pmid=23609101 |doi=10.7326/0003-4819-158-10-201305210-00642 |url=}}</ref><ref name="pmid24842417">{{cite journal |vauthors=LeFevre ML |title=Screening for suicide risk in adolescents, adults, and older adults in primary care: U.S. Preventive Services Task Force recommendation statement |journal=Ann. Intern. Med. |volume=160 |issue=10 |pages=719–26 |date=May 2014 |pmid=24842417 |doi=10.7326/M14-0589 |url=}}</ref>
*Screening for depression  
*Screening for depression  
However, there is no evidence that routine screening for suicidal ideation in adolescent primary care patients reduces suicide attempts or mortality. Systematic reviews for the United States Preventive Services Task Force (USPSTF) have concluded that the evidence is insufficient to determine the benefits of screening for suicide risk in the general population of United States adolescents who do not have existing mental disorders or past histories of suicide attempts [8,9]. However, there is evidence that certain screens for suicidal risk will indeed identify suicidal adolescents [7,10], but whether that identification translates into improved outcomes has yet to be tested or proven.
The USPSTF clinical practice guideline for screening for suicide risk, as well as other USPSTF guidelines, can be accessed through the website for the Agency for Healthcare Research and Quality.


'''Emergency department''' — For youth evaluated in the emergency department by non-mental health clinicians, a brief screening tool may have some value in identifying risk for suicidal behavior. The Ask Suicide-Screening Questions is a four-item instrument that clinicians can administer to screen for risk of suicide in patients who present to pediatric emergency departments with psychiatric or general medical complaints [10]. The four items are:
'''Emergency department'''
*The Ask Suicide-Screening Questions is a four-item instrument that clinicians can administer to screen for risk of suicide in patients who present to pediatric emergency departments with psychiatric or general medical complaints. <ref name="pmid23027429">{{cite journal |vauthors=Horowitz LM, Bridge JA, Teach SJ, Ballard E, Klima J, Rosenstein DL, Wharff EA, Ginnis K, Cannon E, Joshi P, Pao M |title=Ask Suicide-Screening Questions (ASQ): a brief instrument for the pediatric emergency department |journal=Arch Pediatr Adolesc Med |volume=166 |issue=12 |pages=1170–6 |date=December 2012 |pmid=23027429 |doi=10.1001/archpediatrics.2012.1276 |url=}}</ref>
*It includes following four items:


●In the past few weeks, have you wished you were dead?
**In the past few weeks, have you wished you were dead?
**In the past few weeks, have you felt that you or your family would be better off if you were dead?
**In the past week, have you been having thoughts about killing yourself?
**Have you ever tried to kill yourself?


●In the past few weeks, have you felt that you or your family would be better off if you were dead?
*A positive response to atleast one of the above mentioned 4 questions trigger a more extensive evaluation of the patient’s risk for suicide.
 
●In the past week, have you been having thoughts about killing yourself?
 
●Have you ever tried to kill yourself?
 
Answering yes to at least one question constitutes a positive screen that should trigger a more extensive evaluation of the patient’s risk for suicide. (See 'Risk assessment of suicidal ideation' below.)
 
A cross-sectional study in patients aged 10 to 21 years who presented to pediatric emergency departments with psychiatric (n = 180) or general medical (n = 344) problems found that the Ask Suicide-Screening Questions had good psychometric properties [10]. Sensitivity was 97 percent and specificity 88 percent. In psychiatric patients, the positive and negative predictive values were 71 and 97 percent; in general medical patients, positive and negative predictive values were 39 and 100 percent. A limitation of the study was that it was cross-sectional rather than assessing true predictive ability.
 
A systematic review found that two other screening instruments for suicidal ideation or behavior in high risk adolescents performed poorly [8].


==References==
==References==
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[[Category:Primary care]]
[[Category:Psychiatry]]
[[Category:Psychiatry]]
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Latest revision as of 00:20, 30 July 2020

Suicide Microchapters

Home

Patient Information

Overview

Classification

Epidemiology and Demographics

Risk Factors

Screening

Physical Examination

Laboratory Findings

Psychiatric evaluation

Treatment

Medical Therapy

Psychotherapy

Pharmacotherapy

Prevention

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Iqra Qamar M.D.[2]

Overview

The United States Preventive Services Task Force (USPSTF) have declared that there is insufficient evidence to determine the benefits of screening for suicide risk in the general population of United States adolescents having no prioe history of mental disorders or previous suicide attempts.

Screening

The United States Preventive Services Task Force (USPSTF) have declared that there is insufficient evidence to determine the benefits of screening for suicide risk in the general population of United States adolescents having no prioe history of mental disorders or previous suicide attempts.[1]

Primary care

  • Direct questioning: Screening adolescents for suicidal ideation by directly asking about it in the context of screening for depression (Practice guidelines from the American Academy of Pediatrics)
  • Patient Health Questionnaire (PHQ-9): A self-report screening tool, such as the nine-item Patient Health Questionnaire (PHQ-9) modified for teens, which screens for depression and as such, includes one item that asks about suicidal ideation[2][3]
  • Screening for depression

Emergency department

  • The Ask Suicide-Screening Questions is a four-item instrument that clinicians can administer to screen for risk of suicide in patients who present to pediatric emergency departments with psychiatric or general medical complaints. [4]
  • It includes following four items:
    • In the past few weeks, have you wished you were dead?
    • In the past few weeks, have you felt that you or your family would be better off if you were dead?
    • In the past week, have you been having thoughts about killing yourself?
    • Have you ever tried to kill yourself?
  • A positive response to atleast one of the above mentioned 4 questions trigger a more extensive evaluation of the patient’s risk for suicide.

References

  1. Shain B (July 2016). "Suicide and Suicide Attempts in Adolescents". Pediatrics. 138 (1). doi:10.1542/peds.2016-1420. PMID 27354459.
  2. O'Connor E, Gaynes BN, Burda BU, Soh C, Whitlock EP (May 2013). "Screening for and treatment of suicide risk relevant to primary care: a systematic review for the U.S. Preventive Services Task Force". Ann. Intern. Med. 158 (10): 741–54. doi:10.7326/0003-4819-158-10-201305210-00642. PMID 23609101.
  3. LeFevre ML (May 2014). "Screening for suicide risk in adolescents, adults, and older adults in primary care: U.S. Preventive Services Task Force recommendation statement". Ann. Intern. Med. 160 (10): 719–26. doi:10.7326/M14-0589. PMID 24842417.
  4. Horowitz LM, Bridge JA, Teach SJ, Ballard E, Klima J, Rosenstein DL, Wharff EA, Ginnis K, Cannon E, Joshi P, Pao M (December 2012). "Ask Suicide-Screening Questions (ASQ): a brief instrument for the pediatric emergency department". Arch Pediatr Adolesc Med. 166 (12): 1170–6. doi:10.1001/archpediatrics.2012.1276. PMID 23027429.

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