The rate of suicide among adolescents in the United States has tripled since the 1950s and now ranks as the third leading cause of death for this age group. As many as 12 percent of children aged 6 to 12 and 53 percent of adolescents aged 13 to 19 have suicidal thoughts, and 8 to 10 percent of all children in the United States attempt suicide at some point during their childhood.
A growing number of these troubled children and adolescents are showing up at hospital emergency departments (EDs) primarily for self-destructive behavior. By asking them just four questions, nonmental health professionals in the ED can quickly identify children and adolescents who are suicidal, a critical first step to getting them into treatment.
In fact, responses to these four questions asked by the triage nurse identified 98 percent of children at risk for suicide, based on a standard 30-item Suicide Ideation Questionnaire (SIQ) later administered to them by a mental health clinician. The four questions assessed major factors in suicide risk: present and past thoughts of suicide, prior self-destructive behavior, and current stressors. Adding the other 10 questions on the Risk of Suicide Questionnaire (RSQ) to these four did not significantly improve the accuracy of identifying suicidal patients. Not only did the RSQ take less than 2 minutes to complete, but ED nurses reported in a poststudy focus group that it reduced the stress of handling such patients.
In addition, patients felt it was acceptable to discuss suicidal thoughts they had kept to themselves. For the most part, parents were relieved that a clinician was delving into a topic that they feared discussing with their children, explains Lisa M. Horowitz, Ph.D., M.P.H. In the study supported by the Agency for Healthcare Research and Quality (National Research Service Award training grant T32 HS00063), Dr. Horowitz and her Harvard Medical School colleagues developed the RSQ, which was administered by a triage nurse to 144 pediatric mental health patients admitted to a hospital ED. All patients were later administered the SIQ.
More details are in "Detecting suicide risk in a pediatric emergency department: Development of a brief screening tool," by Dr. Horowitz, Philip S. Wang, M.D., Dr.P.H., Gerald P. Koocher, Ph.D., and others, in the May 2001 Pediatrics 107(5), pp. 1133-1137.