Adapting suicide risk screening clinical pathways for youth with a prior suicide attempt

This presentation will describe findings on repeat postdischarge suicide attempts following suicide risk screening in the emergency department (ED). This presentation aims to support a 3-tiered suicide risk screening clinical pathway and revisions based on the observation of implementation programs in pediatric healthcare settings. Research suggests that one-third of patients who screen positive for suicide risk will solely endorse a past suicide attempt without current ideation. However, little is known about how the recency of a previous attempt predicts the risk of a future attempt. Three-tiered clinical pathways were developed to feasibly implement universal suicide risk screening and manage the risk of patients who endorse recent suicidal ideation or a past suicide attempt. A secondary analysis of the Ask Suicide-Screening Questions (ASQ) screening data within the Emergency Department Screen for Teens At Risk for Suicide (ED-STARS) study was performed. The sample included patients ages 12 to 17 years who reported a past suicide attempt at baseline in ED, its recency, and received a follow-up call 3 months postdischarge assessing whether they attempted again. Currently available suicide risk screening clinical pathways recommend that clinicians proceed with minimal interventions if a patient reports a prior suicide attempt greater than 1 year ago with no recent ideation. Revised clinical pathways will be discussed. This secondary analysis included 352 participants. Of those patients, 17.3% (61/352) reattempted suicide postdischarge. Of those who reattempted, 50% (31/61) had reported a past suicide attempt within 1 week prior to baseline. At baseline, 19.3% (68/352) of pediatric patients reported a prior suicide attempt that was over 1 year ago with no recent ideation. Of that group, 94.1% (64/68) did not reattempt suicide within 3 months of discharge. Clinical pathways can aid in the implementation of suicide risk screening without overburdening busy practices. These findings support that patients with a distant prior suicide attempt, but no current suicidal ideation, may require minimal ED interventions with potential outpatient care. Importantly, patients reporting past suicide attempts within 1 week of their visit may be at higher risk of reattempting and require further ED interventions.