Adolescent Suicide Risk Screening in the Emergency Department
Adolescent Suicide Risk Screening in the Emergency Department
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DOI：
10.1111/j.1553-2712.2009.00500.x
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发表时间：
2009-11-01
影响因子：
4.4
通讯作者：
Cunningham, Rebecca M.
中科院分区：
文献类型：
--
作者：
King, Cheryl A.;O'Mara, Roisin M.;Cunningham, Rebecca M.
目的：许多自杀的青少年从未获得过心理健康服务。针对这一点，国家自杀预防战略建议在急诊室（ED）筛查自杀风险升高。本横断面研究的目的是检查1）同时的有效性和实用性的青少年自杀风险屏幕中使用的一般医疗ED和2）青少年男性和女性使用两套不同的筛选criterions.Methods的阳性屏幕的患病率：参与者是298名青少年寻求儿科或精神科急诊服务（50%男性，83%白色，16%黑人或非洲裔美国人，5.4%西班牙裔）。入选标准为13至17岁。排除标准为严重认知障碍、无父母或法律的监护人在场提供同意书或生命体征异常。父母或监护人的同意和青少年的同意，获得了61%的连续合格的青少年。高风险定义为1）自杀意念-青少年[SIQ-JR]评分≥ 31或过去3个月内有自杀企图或2）酒精滥用+抑郁（酒精使用障碍识别测试-3 [AUDIT-3]评分≥ 3，雷诺兹青少年抑郁量表-2 [RADS-2]评分≥ 76）。贝克绝望量表（BHS）和问题导向筛选工具的青少年（POSIT）被用来确定并行validity.Results：16%（n = 48）的青少年筛选阳性的自杀风险升高。在这一组中，98%的人报告了严重的自杀意念或最近的自杀企图（46%的企图和意念，10%的企图，42%的意念），27%的人报告了酗酒和抑郁。19%的筛查呈阳性的青少年是由于非精神病原因。三分之一的筛查呈阳性的青少年没有接受任何心理健康或物质使用治疗。证明并行效度，BHS分数的青少年与积极的屏幕和那些积极的屏幕，由于酗酒和抑郁症的POSIT分数表示实质性的损害。增加酒精滥用与共发抑郁症作为一个积极的筛选标准，并没有导致改善的情况下识别。在因抑郁症和酒精滥用而筛查呈阳性的亚组中，除一人（> 90%）外，所有人都报告了严重的自杀意念和/或最近的自杀企图。这个亚组（约17%的青少年筛选阳性）也报告显着更冲动比其他青少年筛选positive.Conclusions：自杀风险屏幕显示的证据，同时有效性。它还证明了在识别1）自杀风险升高的青少年中的实用性，这些青少年因不相关的医疗问题而到艾德就诊，以及2）由于抑郁、酗酒、自杀倾向和冲动的组合而可能处于自杀风险高度升高的青少年亚组。
Objectives:Many adolescents who die by suicide have never obtained mental health services. In response to this, the National Strategy for Suicide Prevention recommends screening for elevated suicide risk in emergency departments (EDs). This cross-sectional study was designed to examine 1) the concurrent validity and utility of an adolescent suicide risk screen for use in general medical EDs and 2) the prevalence of positive screens for adolescent males and females using two different sets of screening criteria.Methods:Participants were 298 adolescents seeking pediatric or psychiatric emergency services (50% male; 83% white, 16% black or African American, 5.4% Hispanic). The inclusion criterion was age 13 to 17 years. Exclusion criteria were severe cognitive impairment, no parent or legal guardian present to provide consent, or abnormal vital signs. Parent or guardian consent and adolescent assent were obtained for 61% of consecutively eligible adolescents. Elevated risk was defined as 1) Suicidal Ideation Questionnaire-Junior [SIQ-JR] score of >= 31 or suicide attempt in the past 3 months or 2) alcohol abuse plus depression (Alcohol Use Disorders Identification Test-3 [AUDIT-3] score of >= 3, Reynolds Adolescent Depression Scale-2 [RADS-2] score of >= 76). The Beck Hopelessness Scale (BHS) and Problem Oriented Screening Instrument for Teenagers (POSIT) were used to ascertain concurrent validity.Results:Sixteen percent (n = 48) of adolescents screened positive for elevated suicide risk. Within this group, 98% reported severe suicide ideation or a recent suicide attempt (46% attempt and ideation, 10% attempt only, 42% ideation only) and 27% reported alcohol abuse and depression. Nineteen percent of adolescents who screened positive presented for nonpsychiatric reasons. One-third of adolescents with positive screens were not receiving any mental health or substance use treatment. Demonstrating concurrent validity, the BHS scores of adolescents with positive screens and the POSIT scores of those with positive screens due to alcohol abuse and depression indicated substantial impairment. The addition of alcohol abuse with co-occurring depression as a positive screen criterion did not result in improved case identification. Among the subgroup screening positive due to depression plus alcohol abuse, all but one (> 90%) also reported severe suicide ideation and/or a recent suicide attempt. This subgroup (approximately 17% of adolescents who screened positive) also reported significantly more impulsivity than other adolescents who screened positive.Conclusions:The suicide risk screen showed evidence of concurrent validity. It also demonstrated utility in identifying 1) adolescents at elevated risk for suicide who presented to the ED with unrelated medical concerns and 2) a subgroup of adolescents who may be at highly elevated risk for suicide due to the combination of depression, alcohol abuse, suicidality, and impulsivity.