Screening for Suicidal Ideation in the Emergency Department

In Part 1 of this video, Cheryl King, PhD, professor in the Departments of Psychiatry and Psychology and Director of the Youth Depression and Suicide Prevention Program at the University of Michigan, Ann Arbor, discusses the importance of developing the CASSY suicide screening tool for youth in emergency departments.

The CASSY is a personalized computerized adaptive tool that assists emergency departments physicians in identifying youth at-risk for suicidal ideation. This tool can assist providers in identifying underlying mental health conditions, such as major depressive disorder and treatment-resistant depression, in adolescents.

In the upcoming Part 2 and Part 3, Dr King will address the research studies that laid the groundwork for the CASSY to be implemented, the acceptability to both parents and youth for this screening tool, next steps in implementation, as well as the stigma of suicidal ideation in youth.

Read the transcript:

Dr. Cheryl King:  Hello. My name is Cheryl King, and I'll be talking to you today about a new and very promising screen for youth suicide risk, the CASSY, which stands for Computerized Adaptive Screen for Suicidal Youth.

I am a psychologist and a professor, a clinical scientist at the University of Michigan in the Medical School in the Department of Psychiatry. I have been working as a clinical scientist to improve our understanding of optimal ways to screen for youth suicide risk, conduct risk assessments and formulations, and intervene effectively.

I've been working in this area for quite a number of years. Why now did we decide to develop this particular new screening tool? There were a couple of reasons for this. I had already started to work on the possibility of screening youth for suicide risk in general medical emergency departments.

The reason I was working there is because one of the reasons we screened for risk is to try to find youth at risk who have never been identified as being at risk before. Nearly half of all youth who die by suicide, they have not previously been identified at risk or made a suicide attempt. They're unrecognized, and their first attempt may be lethal.

These are more likely the boys than the girls. It could be girls or boys, but keep in mind that the majority of youth suicides are male suicides, even though the majority of teenagers that we treat for suicide risk in our mental health settings are girls.

Girls are more likely to share suicidal thoughts. They're more likely to report suicide attempts than boys, even though boys are several times more likely to die by suicide. How do we find the boys at risk and the girls at risk who've been unidentified in time to take preventive measures and give them treatments that may be lifesaving?

That's why we want to screen not only in a mental health setting, where we have more girls than boys coming in. If they're coming in, they're probably likely or more likely that they're sharing that they're at risk. How do we find those that don't come into the mental health setting in time?

The emergency department, the general medical or pediatric emergency department, offers us this opportunity. Youth are coming in for all kinds of reasons. It could be a sports injury. It could be high fever with influenza. It could be they're coming in because they jammed their thumb in a car door. It could be an exacerbation of a chronic medical illness, like diabetes.

It could also be alcohol poisoning, drug overdose, physical altercation that resulted in injury, a single-car traffic accident. Some of the reasons that youth come into the ED suggest that they may even be at increased risk for suicide, things such as alcohol poisoning, drug overdose, physical fighting that results in injury.

When we screen in the ED, we're screening many youth from the community. Nearly 20 percent of youth, adolescents, will visit an ED in any single year. You have a chance to screen large numbers.

Males and females are coming into emergency departments much more evenly than they're coming into our tertiary care mental health settings. It also offers us an opportunity to find and recognize suicide risk in some of the males at risk.

The other reason is that, in the emergency department, there's an opportunity to screen. There's usually a waiting time. Parents often come in. More often than not, they're present. You can share screen findings with them.

We have many youth in the community coming in, boys and girls, some already at elevated risk because of the reasons they're there. They have time, and most of them will agree to complete a very brief screen.

In addition, the National Institute of Mental Health put out a call asking teams to come in with ideas of how can we conduct a project that will yield a new and more accurate teen suicide risk screen. That's how we landed here.

Cheryl King, PhD, is a professor in the Departments of Psychiatry and Psychology and Director of the Youth Depression and Suicide Prevention Program at the University of Michigan. Her research focuses on the development of evidence-based practices for suicide risk screening, assessment, and intervention. She has provided leadership for multiple NIMH-funded projects, including Emergency Department Screen for Teens at Risk for Suicide, which aims to develop a suicide risk screen that can be disseminated nationwide, and 24-Hour Risk for Suicide Attempts in a National Cohort of Adolescents. A clinical psychologist, educator, and research mentor, Dr. King has served as Director of Psychology Training and Chief Psychologist in the Department of Psychiatry and has twice received the Teacher of the Year Award in Child and Adolescent Psychiatry. She is the lead author of Teen Suicide Risk: A Practitioner Guide to Screening, Assessment, and Management. In addition, Dr. King has provided testimony in the US Senate on youth suicide prevention and is a Past President of the American Association of Suicidology, the Association of Psychologists in Academic Health Centers, and the Society for Clinical Child and Adolescent Psychology. She is a current member of the National Advisory Mental Health Council.