Anxiety and Suicide Risk Among Youths in the Emergency Department

Abstract

Source: Powell DS, Lanzillo EC, Jay, SY, et al. Self-reported symptoms of anxiety predict positive suicide risk screening in adolescents presenting to the emergency department. Pediatric Emergency Care. 2022;38(1):22-25; doi:10.1097/PEC.0000000000002234Investigators from multiple institutions conducted a prospective study to assess the prevalence of patient-reported anxiety symptoms among youths presenting to pediatric EDs and the association of anxiety symptoms with suicide risk. Study participants were youths 10-21 presenting to the ED of 3 urban pediatric teaching hospitals in the US. Demographic information was collected on study participants. Patients were classified as presenting to the ED with a medical/surgical or psychiatric chief complaint. Suicide risk was assessed based on participant responses to the Suicidal Ideation Questionnaire (SIQ) and the Ask Suicide-Screening Questions (ASQ). SIQ is a 30-item instrument that assesses severity of suicidal thoughts in the past month; a 15-item version was administered to children <15 years old. ASQ is a 4-item, yes/no questionnaire designed to assess recent suicidal thoughts and lifetime suicidal behavior. Study youths were classified as having a positive screen for suicide risk based on threshold scores on these questionnaires. Participants also were categorized as having anxiety symptoms or depressive mood, a potential confounder, based on a single yes/no question for each. The primary study outcomes were suicide risk and rate of anxiety symptoms; differences between psychiatric and medical/surgical patients were assessed with chi-square tests. Logistic regression analyses were used to assess the independent association between anxiety symptoms and suicide risk; demographic characteristics were included in the models, and depressive mood also was included as a covariate. Separate analyses included all participants in the groups of psychiatric and medical/surgical patients.Data were analyzed on 522 youths with a mean age of 15.3 ±2.6 years; 344 (65.9%) participants presented with a medical/surgical chief complaint and 178 (34.1%) with a psychiatric problem. Overall, 151 (28.9%) screened positive for suicide risk; psychiatric patients were significantly more likely to screen positive than those with a medical/surgical chief complaint (65.7% vs 9.9%; P <0.001). Similarly, 29.9% of participants had anxiety symptoms, including 54.5% of psychiatric and 16.9% of medical/surgical patients (P <0.001). In the logistical model including all study youths, anxiety symptoms (OR, 5.18; 95% CI, 3.06, 8.76), depressive mood (OR, 14.94; 95% CI, 8.56, 26.07), and female sex (OR, 0.56; 95% CI, 0.32, 0.96) were independent predictors for screening positive for suicide risk. In the model including youths presenting with a medical/surgical complaint, only anxiety (OR, 4.87; 95% CI, 2.09, 11.36) and depressive mood (OR, 6.7; 95% CI, 2.49, 18.03) were independently associated with a positive screen for suicide risk. Anxiety symptoms and depressive mood also were significantly associated with a positive screen for suicide risk in psychiatric patients.The authors conclude that suicidal ideation and anxiety symptoms are prevalent among youths presenting to pediatric EDs.Dr Doolittle has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.While the primary aim of the current investigators was to evaluate the association of anxiety and depression with suicidal risk, the study results reveal the widespread prevalence of mental health issues among adolescents presenting to the ED. Suicide was the second leading cause of death, behind accidents, among youths between 10-24 years old, with 6,759 deaths in 2017.1 While more than one-third of all adolescents presenting to the ED do so with a primary mental health disorder, the prevalence of suicide risk and anxiety also was quite high among medical/surgical study patients (1 in 6 patients). The study results emphasize the need to equip EDs with robust mental health resources. Further, the findings highlight the importance of expanding community-based mental health services, so that patients do not need to present to the ED.Although the current investigators evaluated adolescents presenting to the ED, at some point during adolescence, the prevalence of passive suicidal ideation is 22.2%, serious suicidal ideation is 9.8%, and suicide attempt is 6.7%.2 The prevalence of any anxiety disorder is 31.9% and major depressive disorder 12.0%.3 Mental health issues are challenging for health care providers to diagnose and treat. For example, less than 50% of adolescents with depression receive treatment.3 The pervasiveness of suicidal risk and anxiety among adolescents alerts healthcare providers to the importance of screening and careful inquiry into mental health issues for all patients.Symptoms of anxiety, depression, and suicide risk are prevalent among adolescents presenting to the ED. Patients with severe anxiety are at greater risk of endorsing suicidality.The results of the current study may reflect the heightened levels of psychological distress associated with the COVID-19 pandemic.4 The narrow geographic sample and cross-sectional design, however, limit the generalizability of the results of the current study. (S AAP Grand Rounds. 2022;47[3]:30.)5