Cheryl A King1, David Brent2, Jacqueline Grupp-Phelan3, T Charles Casper4, J Michael Dean4, Lauren S Chernick5, Joel A Fein6, E Melinda Mahabee-Gittens7, Shilpa J Patel8, Rakesh D Mistry9, Susan Duffy10,11, Marlene Melzer-Lange12, Alexander Rogers13,14, Daniel M Cohen15, Allison Keller16, Rohit Shenoi17, Robert W Hickey18, Margaret Rea19, Mary Cwik20, Kent Page4, Taylor C McGuire1, Jiebiao Wang21, Robert Gibbons22,23,24,25. 1. Department of Psychiatry, University of Michigan, Ann Arbor. 2. Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania. 3. Department of Emergency Medicine, University of California, San Francisco, San Francisco. 4. The University of Utah School of Medicine, Salt Lake City. 5. Department of Emergency Medicine and Pediatrics, Columbia University Medical Center, New York, New York. 6. Center for Violence Prevention, Children's Hospital of Philadelphia, Division of Emergency Medicine, University of Pennsylvania, Philadelphia. 7. Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio. 8. Division of Emergency Medicine, Children's National Hospital, Washington, DC. 9. Department of Pediatrics-Emergency Medicine, University of Colorado School of Medicine, Aurora. 10. Department of Emergency Medicine, Alpert Medical School at Brown University, Providence, Rhode Island. 11. Department of Pediatrics, Alpert Medical School at Brown University, Providence, Rhode Island. 12. Department of Pediatrics, Medical College of Wisconsin, Milwaukee. 13. Department of Emergency Medicine, University of Michigan, Ann Arbor. 14. Department of Pediatrics, University of Michigan, Ann Arbor. 15. Division of Emergency Medicine, Nationwide Children's Hospital, Columbus, Ohio. 16. Department of Pediatric Emergency Medicine, The University of Utah, Salt Lake City. 17. Department of Pediatrics, Baylor College of Medicine, Houston, Texas. 18. Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania. 19. Medical Center at the University of California School of Medicine, Davis, Sacramento. 20. Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. 21. Department of Statistics and Data Science, Carnegie Mellon University, Pittsburgh, Pennsylvania. 22. Department of Medicine, The University of Chicago, Chicago, Illinois. 23. Department of Public Health Sciences (Biostatistics), The University of Chicago, Chicago, Illinois. 24. Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, Illinois. 25. Department of Comparative Human Development, The University of Chicago, Chicago, Illinois.
Abstract
Importance: The rate of suicide among adolescents is rising in the US, yet many adolescents at risk are unidentified and receive no mental health services. Objective: To develop and independently validate a novel computerized adaptive screen for suicidal youth (CASSY) for use as a universal screen for suicide risk in medical emergency departments (EDs). Design, Setting, and Participants: Study 1 of this prognostic study prospectively enrolled adolescent patients at 13 geographically diverse US EDs in the Pediatric Emergency Care Applied Research Network. They completed a baseline suicide risk survey and participated in 3-month telephone follow-ups. Using 3 fixed Ask Suicide-Screening Questions items as anchors and additional items that varied in number and content across individuals, we derived algorithms for the CASSY. In study 2, data were collected from patients at 14 Pediatric Emergency Care Applied Research Network EDs and 1 Indian Health Service hospital. Algorithms were independently validated in a prospective cohort of adolescent patients who also participated in 3-month telephone follow-ups. Adolescents aged 12 to 17 years were consecutively approached during randomly assigned shifts. Exposures: Presentation at an ED. Main Outcome and Measure: A suicide attempt between ED visit and 3-month follow-up, measured via patient and/or parent report. Results: The study 1 CASSY derivation sample included 2075 adolescents (1307 female adolescents [63.0%]; mean [SD] age, 15.1 [1.61] years) with 3-month follow-ups (72.9% retention [2075 adolescents]). The study 2 validation sample included 2754 adolescents (1711 female adolescents [62.1%]; mean [SD] age, 15.0 [1.65] years), with 3-month follow-ups (69.5% retention [2754 adolescents]). The CASSY algorithms had excellent predictive accuracy for suicide attempt (area under the curve, 0.89 [95% CI, 0.85-0.91]) in study 1. The mean number of adaptively administered items was 11 (range, 5-21). At a specificity of 80%, the CASSY had a sensitivity of 83%. It also demonstrated excellent accuracy in the study 2 validation sample (area under the curve, 0.87 [95% CI, 0.85-0.89]). In this study, the CASSY had a sensitivity of 82.4% for prediction of a suicide attempt at the 80% specificity cutoff established in study 1. Conclusions and Relevance: In this study, the adaptive and personalized CASSY demonstrated excellent suicide attempt risk recognition, which has the potential to facilitate linkage to services.
Importance: The rate of suicide among adolescents is rising in the US, yet many adolescents at risk are unidentified and receive no mental health services. Objective: To develop and independently validate a novel computerized adaptive screen for suicidal youth (CASSY) for use as a universal screen for suicide risk in medical emergency departments (EDs). Design, Setting, and Participants: Study 1 of this prognostic study prospectively enrolled adolescent patients at 13 geographically diverse US EDs in the Pediatric Emergency Care Applied Research Network. They completed a baseline suicide risk survey and participated in 3-month telephone follow-ups. Using 3 fixed Ask Suicide-Screening Questions items as anchors and additional items that varied in number and content across individuals, we derived algorithms for the CASSY. In study 2, data were collected from patients at 14 Pediatric Emergency Care Applied Research Network EDs and 1 Indian Health Service hospital. Algorithms were independently validated in a prospective cohort of adolescent patients who also participated in 3-month telephone follow-ups. Adolescents aged 12 to 17 years were consecutively approached during randomly assigned shifts. Exposures: Presentation at an ED. Main Outcome and Measure: A suicide attempt between ED visit and 3-month follow-up, measured via patient and/or parent report. Results: The study 1 CASSY derivation sample included 2075 adolescents (1307 female adolescents [63.0%]; mean [SD] age, 15.1 [1.61] years) with 3-month follow-ups (72.9% retention [2075 adolescents]). The study 2 validation sample included 2754 adolescents (1711 female adolescents [62.1%]; mean [SD] age, 15.0 [1.65] years), with 3-month follow-ups (69.5% retention [2754 adolescents]). The CASSY algorithms had excellent predictive accuracy for suicide attempt (area under the curve, 0.89 [95% CI, 0.85-0.91]) in study 1. The mean number of adaptively administered items was 11 (range, 5-21). At a specificity of 80%, the CASSY had a sensitivity of 83%. It also demonstrated excellent accuracy in the study 2 validation sample (area under the curve, 0.87 [95% CI, 0.85-0.89]). In this study, the CASSY had a sensitivity of 82.4% for prediction of a suicide attempt at the 80% specificity cutoff established in study 1. Conclusions and Relevance: In this study, the adaptive and personalized CASSY demonstrated excellent suicide attempt risk recognition, which has the potential to facilitate linkage to services.
Authors: Emily E Haroz; Christopher Kitchen; Paul S Nestadt; Holly C Wilcox; Jordan E DeVylder; Hadi Kharrazi Journal: Suicide Life Threat Behav Date: 2021-09-13