Abstract
Objective
Describe pediatricians’ experiences, attitudes, and practices around suicide prevention
within primary care, and examine associations between pediatricians’ experiences and
practices.
Methods
The nationally representative Periodic Survey of American Academy of Pediatrics members
provided data on pediatricians’ patient experience with suicide risk, perceived barriers
to screening for suicidal ideation (SI), preparedness to counsel about suicide prevention,
interest in learning more about suicide prevention strategies, and frequency of screening
for and managing suicidal ideation. Multivariable analyses examined the effect of
having a patient die by or attempt suicide on screening practices.
Results
A total of 41% responded to the survey with 377 respondents in the analytic sample.
A total of 93% of pediatricians had a patient screen positive for SI and 81% had a
patient attempt or die by suicide. A total of 61% always screened for SI and 63% reported
using a standardized depression screening tool and 9% a suicide-specific tool. Respondents
who had a patient attempt or die by suicide were more likely to screen for SI (OR,
2.05, 95% CI, 1.16–3.63) and use a standardized depression screening instrument (OR,
2.34, 95% CI, 1.29–4.24). Patient reluctance to discuss mental health was the most
frequently cited barrier (51%) followed by lack of time (49%) and lack of treatment
options (43%). Over 90% of respondents assessed for a plan and referred to mental
health services when suicidal ideation was identified.
Conclusion
Although pediatricians frequently see patients with suicide risk, 39% do not always
screen for SI. Educational efforts are needed to improve pediatricians’ assessment
and management of suicide risk given new guidelines.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Academic PediatricsAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
AAP, AACAP. CHA declare national emergency in children’s mental health. Pediatr News. 2021. Available at: https://publications-aap-org.ezproxy.med.cornell.edu/aapnews/news/17718. Accessed February 15, 2023.
The U.S. Surgeon General’s Advisory. Protecting youth’s mental health: the U.S. surgeon general’s report. U.S. Department of Health and Human Services, Public Health Service, Office of the Surgeon General; 2021:34982518
Center for Disease Control and Prevention. Web-based injury statistics query and reporting system (WISQARS) 2021. Available at: https://wisqars.cdc.gov/data/lcd/home, Accessed January 15, 2023.
- Suicide ideation and attempts in a pediatric emergency department before and during COVID-19.Pediatrics. 2021; 147e2020029280https://doi.org/10.1542/peds.2020-029280
- Suicide risk in adolescents during the COVID-19 pandemic.Pediatrics. 2022; 149e2021053486https://doi.org/10.1542/peds.2021-053486
Gorzkowski J, Calabrese T, Lau M, et al. Blueprint for youth suicide prevention. American Academy of Pediatrics. Available at:https://www.aap.org/en/patient-care/blueprint-for-youth-suicide-prevention/, Accessed December 22, 2022.
- Health care contacts in the year before suicide death.J Gen Intern Med. 2014; 29: 870-877
- ED-SAFE-Can suicide risk screening and brief intervention initiated in the emergency department save lives?.JAMA Psychiatry. 2017; 74: 555-556
- Validation and feasibility of the ASQ among pediatric medical and surgical inpatients.Hosp Pediatr. 2020; 10: 750-757
- Integrating suicide risk screening into pediatric ambulatory subspecialty care.Pediatr Qual Saf. 2020; 5: e310
- Implementing suicide risk screening in a pediatric primary care setting: from research to practice.Acad Pediatr. 2022; 22: 217-226
- Adolescent patients–healthy or hurting? Missed opportunities to screen for suicide risk in the primary care setting.Arch Pediatr Adolesc Med. 2000; 154: 162-168
- Competency of future pediatricians caring for children with behavioral and mental health problems.Pediatrics. 2020; 146e20192884https://doi.org/10.1542/peds.2019-2884
- Preparedness of pediatric subspecialty fellows to address emotional and mental health needs among children with chronic medical conditions.JAMA Pediatr. 2022; 176: 1266-1268
- COMMITTEE ON ADOLESCENCE. Suicide and suicide attempts in adolescents.Pediatrics. 2016; 138e20161420https://doi.org/10.1542/peds.2016-1420
- Comparison of performance on ADHD quality of care indicators: practitioner self-report versus chart review.J Atten Disord. 2016; 24: 1457-1461
American Board of Pediatrics. Latest race and ethnicity data for pediatricians and pediatric trainees. Estimating the race and ethncity of pediatric trainees and certified pediatricians: an interim report based on data collected from 2018-2021. Available at: https://www.abp.org/node/1159/printable/print, Accessed January 15, 2023. .
- Validation of the ask suicide-screening questions (ASQ) with youth in outpatient specialty and primary care clinics.Gen Hosp Psychiatry. 2021; 68: 52-58
- Universal pediatric suicide risk screening in a health care system: 90,000 patient encounters.J Acad Consult Liaison Psychiatry. 2021; 62: 421-429
- Screening pediatric medical patients for suicide risk: Is depression screening enough?.J Adolesc Health. 2021; 68: 1183-1188
- Guidelines for adolescent depression in primary care (GLAD-PC): I. identification, assessment, and initial management.Pediatrics. 2007; 120: e1299-e1312
AAP Research. 56% of pediatricians say they can complete recommended screenings. AAP News, September 1, 2020.
- Identifying adolescent suicide risk via depression screening in pediatric primary care: an electronic health record review.Psychiatr Serv. 2021; 72: 163-168
- Standardized screening for suicidal adolescents in primary care.Pediatrics. 2010; 125: 938-944
- Parent and adolescent thoughts about suicide risk screening in pediatric outpatient settings.Arch Suicide Res. 2022; 26: 1173-1185
- Evaluating iatrogenic risk of youth suicide screening programs: a randomized controlled trial.JAMA. 2005; 293: 1635-1643
- Does asking about suicide and related behaviours induce suicidal ideation? What is the evidence?.Psychol Med. 2014; 44: 3361-3363
- Changes in firearm and medication storage practices in homes of youths at risk for suicide: results of the SAFETY study, a clustered, emergency department-based, multisite, stepped-wedge trial.Ann Emerg Med. 2020; 76: 194-205
- Suicide prevention in an emergency department population: the ED-SAFE study.JAMA Psychiatry. 2017; 74: 563-570
- Comparison of the safety planning intervention with follow-up vs usual care of suicidal patients treated in the emergency department.JAMA Psychiatry. 2018; 75: 894-900
- Association of youth suicides and county-level mental health professional shortage areas in the US.JAMA Pediatr. 2023; 177: 71-80
- Pediatric mental health presentations and boarding: first year of the COVID-19 pandemic.Hosp Pediatr. 2022; 12: 751-760
- Mental health service use before and after a suicidal crisis among children and adolescents in a United States National Medicaid Sample.Acad Pediatr. 2021; 21: 1171-1178
- Trends in use of electronic health records in Pediatric Office Settings.J Pediatr. 2019; 206: 164-171.e162
AAP Research. 100th Periodic Survey compares pediatricians’ concerns in 1987 with 2018. AAP News: American Academy of Pediatrics; 2019.
- The New York project TEACH (CAP-PC and CAPES Programs): origins and successes.Gen Hosp Psychiatry. 2014; 36: 551-552
Article info
Publication history
Published online: January 30, 2023
Accepted:
January 21,
2023
Received:
July 28,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
The authors have no conflicts of interest relevant to this article to disclose.
Identification
Copyright
Copyright © 2023 by Academic Pediatric Association
