Identifying Adolescent Suicide Risk via Depression Screening in Pediatric Primary Care: An Electronic Health Record Review.

OBJECTIVE: The authors evaluated suicide risk rates detected via a depression screener administered within a large pediatric primary care system and examined 1-year follow-up care after adolescents' endorsement of suicide risk.
METHODS: Retrospective electronic health record data were extracted to examine both suicide risk rates from items endorsed on the Patient Health Questionnaire-Modified for Teens (PHQ-9-M) and primary care providers' (PCPs') follow-up suicide risk assessments on the day of depression screening among adolescents ages 12-18 years during the period of September 1, 2014, to August 31, 2016. Manual chart review was conducted, and charts were coded for several follow-up care actions (e.g., referral to behavioral health providers and provision of crisis line information) in the year after suicidality endorsement.
RESULTS: In a sample of 12,690 adolescents, 5.1% endorsed thoughts of death or self-harm, 3.6% reported a lifetime suicide attempt, and 2.4% endorsed serious suicidal ideation within the past month. Manual chart review of a stratified random subsample of 150 of the 643 adolescents who endorsed a lifetime suicide attempt, serious ideation in the past month, or both illustrated the types of follow-up care they received. The PCPs adhered to the system's suicide assessment questions with high fidelity. Follow-up care from PCPs and other providers during the year after suicide risk endorsement was more variable.
CONCLUSIONS: Findings demonstrate the feasibility of incorporating suicide assessment procedures into depression screening in pediatric primary care and highlight avenues for maximizing preventive care for adolescents at increased risk for suicide.