Differences in Reporting Suicide Ideation and Attempt: Implications for Suicide Risk Screening in Pediatric Primary Care

Abstract

Objective

Pediatricians are uniquely positioned to identify suicide-related risk, yet clinical practices as to when, how, and who gets screened may vary due to differences in policy statements on youth suicide risk screening in primary care. To address these differences, we examined agreement between reports of past suicide ideation (SI) and suicide attempt (SA) across multiple assessment methods and over time. We further explored associations across sociodemographic factors and severity of mental health symptoms on reporting patterns on these methods for adolescents at elevated risk.

Methods

Adolescents (N = 162) with SI and/or SA were recruited from multiple clinical sites in and around New York City. Adolescents completed interviews and self-report measures validated to assess suicide-related risk, depressive symptoms, and anxiety symptoms.

Results

Agreement between questions on verbal interviews over time was fair (κ = 0.38), with adolescents under-reporting lifetime SI as time from a crisis went by. Agreement between questions on self-report measures was moderate (κ = 0.51), with adolescents under-reporting past-month SI on a depression screen compared to a suicide-specific screen. Participants with less severe mental health-related symptoms were significantly less likely to report past-month SI consistently.

Conclusions

This study highlights important trends in suicide-related reporting patterns among adolescents at elevated risk for suicide and may have important implications for clinical practice guidelines. To capture more adolescents at risk for suicide, results not only support a universal screening approach using suicide-specific tools but may suggest the need to increase screening frequency in pediatric primary care.