Adolescent suicide assessment and management in primary care

M Aalsma, J Keys, S Ferrin, M Shan, T Garbuz, T Scott, Z Adams, L Hulvershorn, S Downs, M Aalsma, J Keys, S Ferrin, M Shan, T Garbuz, T Scott, Z Adams, L Hulvershorn, S Downs

Abstract

Background: To understand how suicide management occurs within the primary care setting in terms of follow-up assessments and referral practices.

Methods: At an initial primary care visit, adolescents (aged 12-20 years old) completed electronic screening. Data were focused on youth who endorsed a suicidal risk item while completing screening at two Midwestern primary care clinics. Data were collected through retrospective chart reviews to analyze actions taken by the primary care physician at the youth's initial visit and follow-up visit within the next 12 months.

Results: At initial visits 200 adolescents endorsed a suicidal risk item and 39 (19.5%) were considered to be concerning by their primary care physician. The average age was 14.7 years old (SD ± 2.0). Seventy-two percent (n = 144) were female, and 65% (n = 129) identified as Black. At initial visits, significant differences between suicidal concern groups were found in reporting active suicidal ideation, past suicide attempts, those who were referred to behavioral health counseling, and those who had a diagnosis of depression. Interestingly, only 13% (n = 25) of all patients who endorsed the suicide item were asked whether or not there were weapons in their home and primary care providers asked only 7% (n = 13) of all patients whether they had a safety plan.

Conclusions: There was inconsistent follow-up for adolescents with a history of suicide concerns. At this time, national guidelines do not exist regarding primary care follow-up of youth with suicide concerns. Guidelines are a necessary precursor for practice improvement.

Trial registration: Clinical Trials Registry: NCT02244138 . Registration date, September 1, 2014.

Keywords: Adolescent; Computer decision support systems; Primary care; Screening; Suicide.

Conflict of interest statement

Matthew Aalsma, Joann Keys, Stephanie Ferrin, Mu Shan, Tamila Garbuz, Taylor Scott, Zachary Adams and Leslie Hulvershorn have no competing interests to disclose. Stephen Downs is co-owner of the computer decision support system (CHICA).

© 2022. The Author(s).

References

    1. National Center for Health Statistics. About mulitple causes of death, 1999–2020. Hyattsville, MD: US Department of Health and Human Services. CDC. National Center for Health Statistics; 2021. . Accessed 4 Apr 2022.
    1. Ivey-Stephenson AZ, Demissie Z, Crosby AE, et al. Suicidal ideation and behaviors among high school students—youth risk behavior survey, united states, 2019. MMWR supplements. 2020;69(1):47–55. doi: 10.15585/mmwr.su6901a6.
    1. Nock MK, Green JG, Hwang I, et al. Prevalence, correlates, and treatment of lifetime suicidal behavior among adolescents: Results from the national comorbidity survey replication adolescent supplement. JAMA Psychiat. 2013;70(3):300–310. doi: 10.1001/2013.jamapsychiatry.55.
    1. Abraham ZK, Sher L. Adolescent suicide as a global public health issue. Int J Adolesc Med Health. 2017;31(4):1–9.
    1. Selden TM. Compliance with well-child visit recommendations: Evidence from the medical expenditure panel survey, 2000–2002. Pediatrics. 2006;118(6):e1766–1778. doi: 10.1542/peds.2006-0286.
    1. Ahmedani BK, Simon GE, Stewart C, et al. Health care contacts in the year before suicide death. J Gen Intern Med. 2014;29(6):870–877. doi: 10.1007/s11606-014-2767-3.
    1. Zuckerbrot RA, Cheung A, Jensen PS, et al. Guidelines for adolescent depression in primary care (GLAD-PC): Part I. Practice preparation, identification, assessment, and initial management. Pediatrics. 2018;141(3):1–21. doi: 10.1542/peds.2017-4081.
    1. Cheung AH, Zuckerbrot RA, Jensen PS, et al. Guidelines for Adolescent Depression in Primary Care (GLADPC): Part II. Treatment and Ongoing Management. Pediatrics. 2018;141(3):e20174082.
    1. Western Interstate Commission for Higher Education Mental Health Program (WICHE MHP), Suicide Prevention Resource Center (SPRC). Suicide prevention toolkit for primary care practices. A guide for primary care providers and medical practice managers (Rev. ed.). Boulder: WICHE MHP & SPRC; 2017.
    1. Shain B. Suicide and suicide attempts in adolescents. Pediatrics. 2016;138(1):e2–e11. doi: 10.1542/peds.2016-1420.
    1. National Institute for Health and Care Excellence . Self-harm in over 8s: Short-term management and prevention of recurrence. Clinical guideline [CG16] 2004.
    1. Morgan C, Webb RT, Carr MJ, et al. Incidence, clinical management, and mortality risk following self harm among children and adolescents: Cohort study in primary care. BMJ. 2017;359:1–9.
    1. Davis M, Rio V, Farley AM, et al. Identifying adolescent suicide risk via depression screening in pediatric primary care: An electronic health record review. Psychiatr Serv. 2021;72(2):163–168. doi: 10.1176/appi.ps.202000207.
    1. Faghri NMA, Boisvert CM, Faghri S. Understanding the expanding role of primary care physicians (PCPs) to primary psychiatric care physicians (PPCPs): Enhancing the assessment and treatment of psychiatric conditions. Ment Health Fam Med. 2010;7(1):17–25.
    1. Olfson M, Kroenke K, Wang S, Blanco C. Trends in office-based mental health care provided by psychiatrists and primary care physicians. J Clin Psychiatry. 2014;75(3):247–253. doi: 10.4088/JCP.13m08834.
    1. Geoffrey RS, Cynthia B, Graham AB, 3rd, et al. 2014 recommendations for pediatric preventive health care. Pediatrics. 2014;133(3):568–570. doi: 10.1542/peds.2013-4096.
    1. Alderman EM. AMA Guidelines for adolescent preventive services (GAPS): Recommendations and rationale. JAMA. 1994;272(12):980–981. doi: 10.1001/jama.1994.03520120090040.
    1. Anand V, Biondich PG, Liu GC, et al. Child health improvement through computer automation: the CHICA system. Medinfo. 2004;107:187–191.
    1. Anand V, Carroll AE, Biondich PG, et al. Pediatric decision support using adapted arden syntax. Artif Intell Med. 2018;92:15–23. doi: 10.1016/j.artmed.2015.09.006.
    1. Carroll AE, Bauer NS, Dugan TM, et al. Use of a computerized decision aid for ADHD diagnosis: A randomized controlled trial. Pediatrics. 2013;132(3):e623–e629. doi: 10.1542/peds.2013-0933.
    1. Gilbert AL, Downs SM. Medical legal partnership and health informatics impacting child health: Interprofessional innovations. J Interprof Care. 2015;29(6):564–569. doi: 10.3109/13561820.2015.1029066.
    1. Gould MS, Greenberg T, Velting DM, Shaffer D. Youth suicide risk and preventive interventions: A review of the past 10 years. J Am Acad Child Adolesc Psychiatry. 2003;42(4):386–405. doi: 10.1097/.
    1. Kolves K, de Leo D. Suicide methods in children and adolescents. Eur Child Adolesc Psychiatry. 2017;26(2):155–164. doi: 10.1007/s00787-016-0865-y.
    1. Bandealy A, Herrera N, Weissman M, Scheidt P. Use of lethal means restriction counseling for suicide prevention in pediatric primary care. Prev Med. 2019;130:1–7.
    1. Boggs JM, Quintana LM, Powers JD, Hochberg S, Beck A. Frequency of clinicians' assessments for access to lethal means in persons at risk for suicide. Arch Suicide Res. 2022;26(1):127–136. doi: 10.1080/13811118.2020.1761917.
    1. Rowhani-Rahbar A, Simonetti JA, Rivara FP. Effectiveness of interventions to promote safe firearm storage. Epidemiol Rev. 2016;38(1):111–124.
    1. Hunter CL, Goodie JL, Oordt MS, Dobmeyer AC. Integrated behavioral health in primary care: Step-by-step guidance for assessment and intervention. 2. Washington, DC, US: American Psychological Association; 2017.
    1. Aston J, Wilson KA, Terry DRP. The treatment-related experiences of parents, children and young people with regular prescribed medication. Int J Clin Pharm. 2019;41(1):113–121. doi: 10.1007/s11096-018-0756-z.
    1. Dueweke AR, Bridges AJ. Suicide interventions in primary care: A selective review of the evidence. Fam Syst Health. 2018;36(3):1–15.
    1. Wintersteen MB, Diamond GS. Youth suicide prevention in primary care: A model program and its impact on psychiatric emergency referrals. Clin Pract Pediatr Psychol. 2013;1(3):295–305. doi: 10.1037/cpp0000028.
    1. Zero Suicide. Education Development Center. Available at: . Published 2020. Accessed 23 Nov 2020.

Source: PubMed

Sponsorit ja yhteistyökumppanit

Sairaudet

Huumeiden interventiot

3
Tilaa