ABSTRACT
Introduction
We compare suicidal behavior outcomes for adolescents who select “no response” on Ask Suicide-Screening Questions (ASQ) items in the emergency department (ED) with those of adolescents who screen negative or positive.
Methods
The multisite Emergency Department Screen for Teens at Risk for Suicide (ED-STARS) study prospectively enrolled adolescents at ED visits, randomizing a subset to follow-up of six-month duration. Participants and parents/guardians completed mental health surveys during the ED encounter and (if applicable) at 3- and 6-month. Risk group was assigned based on ED ASQ score (positive, negative, or nonresponse). Primary outcomes were suicidal ideation, suicide attempt, and mental health service use within 6 months.
Results
There were 6411 participants assigned to an ASQ group; 2296 participated in follow-up. Nonresponse was associated with intermediate risk for suicidal ideation (nonresponse group adjusted odds ratio [OR] 2.14 [95% CI 1.33–3.41]; positive group 4.35 [2.93–6.51]), attempt (nonresponse group adjusted OR 2.82 [0.97–8.41]; positive group 5.35 [2.25–14.33]), and mental health care receipt (nonresponse group unadjusted OR 3.42 [1.56–7.59]; positive group 9.88 [5.60–17.79]).
Conclusions
Youth choosing nonresponse on suicide screening questions may be at elevated risk for suicidal ideation and behavior; ED clinicians should not default to treating these youth as negative screens.