Suicide Risk Screening Research Articles

MANAGEMENT OF SUICIDALITY IN ADOLESCENTS WITH TYPE 1 DIABETES (T1D)

Suicidality in adolescents with type 1 diabetes (T1D) presents unique management challenges for clinicians. Suicide risk screening is critical in this high-risk population to provide appropriate mental health care (MHC). An embedded child and adolescent psychiatrist within subspecialty clinics improves access to higher level MHC and subspecialty provider competence in managing mental health concerns. Psychological distress compromises medication adherence, T1D management, and glycemic control. Motivational interviewing (MI) is an effective framework to empower patients to improve their physical and mental health.

2.114 Chief Complaints Predicting Positive Suicide Risk Screen in the Emergency Department

The goals of this study are to examine factors associated with completed screening for suicide risk in the emergency department, and to examine clinical patterns of risk for suicide in children with physical health and mental health chief complaints in universal screening in the emergency department.

24.2 When the Ask Suicide-Screening Questions (ASQ) Toolkit Is Positive: Safety Planning in Children With Neurodevelopmental Disorders

Historically, children with neurodevelopmental disabilities (NDDs) were thought to be at lower risk of suicidal ideation and behaviors than typically developing children. Based on clinical experience and universal suicide risk screening implemented at our institute, the NDD population was found to have similar positivity rates as the neurotypical population. This reflects a gap in the understanding and treatment of suicide risk in children and adolescents with NDD. This discussion will highlight the screening results at our institute and focus on the follow-up and safety planning for children with positive screening.

IDENTIFICATION AND ASSESSMENT OF SUICIDALITY IN PATIENTS WITH NEURODEVELOPMENTAL DISORDERS AND ASD

Our session will focus on the art of addressing suicidal thoughts and behaviors in children with neurodevelopmental disorders (NDDs), including ASD. This population has long been thought to be at low risk for suicidal thoughts and behaviors but recent studies suggest higher risk. When standardized and universal suicide risk screening was implemented at our healthcare setting, it was identified that children with NDDs are at risk and need intervention from psychiatrists and other mental health providers.

Clinical Pathway for Suicide Risk Screening in Adult Primary Care Settings: Special Recommendations.

Suicide is a serious public health concern. On average, 80% of suicide decedents had contact with primary care within 1 year of their suicide. This and other research underscore the importance of screening for suicide risk within primary care settings, and implementation of suicide risk screening is already underway in many practices. However, while primary care practices may be familiar with screening for other mental health concerns (e.g., depression), many feel uncomfortable or unprepared for suicide risk screening. To meet the increasing demand for evidence-based suicide-risk-screening guidance, we provide a clinical pathway for adult primary care practices (to include family medicine, internal medicine, women's health). The pathway was developed by experts with research, clinical expertise, and experience in suicide risk screening and primary care. We also provide detailed guidance to aid primary care practices in their decisions about how to implement the clinical pathway.

Development and Validation of the Self-Rating Suicide Risk Screening Questionnaire.

Since suicide is one of the major health problems worldwide, the goal of the present study is to develop a psychometrically sound suicide risk screening tool named Suicide Screening Questionnaire- Self-Rating (SSQ-SR) to quantify the risk of suicidal behavior. The development process includes item generation, item revision and refinement, and validation. A total sample of 2,238 adults in South Korea was used for analysis. The results of factor analysis showed that the SSQ-SR, containing 25 items, supported a three-factor model: "Situational factors," "Negative self-perceptions and mental health factors," and "Suicidal thoughts and behaviors." Also, SSQ-SR showed satisfying internal consistency, concurrent validity and discriminant validity. Lastly, the results of ROC analysis showed a cut-off point of 33.5 for the low-risk group and 36.5 for the high-risk group. Considering these results, the current results demonstrate the SSQ-SR is a valid scale and therefore can contribute to future suicide-related studies and prevention.

Primary Care and Mental Health Staff Perspectives on Universal Suicide Risk Screening and Care Coordination.

Little is known about staff or patient perspectives on suicide risk screening programs. The objectives of this study were to characterize Veterans Health Administration (VHA) primary care and mental health staff perspectives regarding the VHA Suicide Risk Identification Strategy screening and assessment program and to describe coordination of suicide prevention-related care following positive screening results. Qualitative interviews were conducted with 40 primary care and mental health staff at 12 VHA facilities. An inductive-deductive hybrid approach was used to conduct a thematic analysis. Several key themes were identified. Primary care and mental health staff participants accepted having a structured process for screening for suicidal ideation and conducting risk assessments, but both groups noted limitations and challenges with initial assessment and care coordination following screening. Mental health staff reported more concerns than primary care staff about negative impacts of the screening and assessment process on treatment. Both groups felt that better training was needed for primary care staff to effectively discuss and evaluate suicide risk. The results suggested that additional modifications of the screening and assessment process are needed for patients already known to have elevated risk of suicide or chronic suicidal ideation.

School Nursing Workforce Differences Between Urban and Non-Urban Areas: Implications for School Health Services and Equity.

The professional experiences of school nurses who work outside of urban areas are not often described. We used data from a 2019 statewide survey of school nurses to describe differences between the urban and non-urban (urban cluster and rural) school nurse workforce in New Mexico. Non-urban school nurses were twice as likely as urban nurses to provide clinical services to multiple school campuses (P < .001) and more likely to serve both elementary and secondary school settings (P = .002). They were less likely than urban school nurses to be bachelor's prepared, or to have received recent continuing education on diabetes (P < .001), reproductive health (P = 0.02), LGBQ+ and transgender student health (P < .001, for each), and suicide risk assessment and screening (P = .012). Our findings underscore concerns about geographic differences in the school nursing workforce in terms of educational preparation and student access that could potentially limit the school nurse role in advancing child health equity.

Adolescent Suicide Risk Screening: A Secondary Analysis of the SHIELD Randomized Clinical Trial

To evaluate the effectiveness of adolescent suicide risk screening to increase initiation of mental health services via a secondary analysis using data from the SHIELD (Screening in High Schools to Identify, Evaluate and Lower Depression) randomized clinical trial, which evaluated school-based screening for major depressive disorder (MDD). Students in 14 Pennsylvania high schools were randomized by grade to either the usual school practice of targeted referral for behavior raising a concern for suicide risk or universal screening using the Patient Health Questionnaire-9 (PHQ-9), with any response >0 to item 9 regarding suicide risk considered positive. Students identified in either arm were referred to the Student Assistance Program (SAP), which is mandated in all Pennsylvania schools. The SAP determined follow-up. Study groups were compared using mixed-effects logistic regression. The participants comprised 12 909 students, with 6473 (50.1%) randomized to universal screening. The study group was 46% female and 43% Hispanic or non-Hispanic Black. Adolescents in the universal screening arm had 7.1-fold greater odds (95% CI, 5.7-8.8) of being identified as at risk for suicide, 7.8-fold greater odds (95% CI, 4.6-13.1) of follow-up needs, and 4.0-fold greater odds (95% CI, 2.0-7.9) of initiating mental health treatment. Although the PHQ-9 is a MDD screening tool, its use in universal screening increased identification and treatment initiation for adolescents at risk for suicide. This confirms the value of universal screening and suggests that a suicide-specific risk assessment would have even greater impact on treatment initiation for identified youth. ClinicalTrials.gov: NCT03716869.

Comparison of violence risk screening experiences of emergency department clinicians

ABSTRACT Objective Individuals commonly present to the emergency department (ED) for care after violence and many are also at risk for subsequent self or other-directed violence. Screening for violence risk represents an important part of ED care, but is challenging to implement effectively. Feedback from ED providers is needed to characterize differences across provider types in order to facilitate implementation of enhanced screening practices. Methods This qualitative focus group study examined the experiences of 6 psychiatric social workers, 16 emergency medicine physicians, and 15 psychiatric providers in conducting violence risk screening to elicit ideas about solutions and barriers. Results Eight themes emerged: Approach to Patient Assessment, High-Yield Clinical Data in Risk Assessment, Suicide Risk Screen, ED Clinician Resources, Analysis of Professional Risk, Affective Response of Clinician, ED Role and Scope, and Clinical Management. All clinician types discussed the themes from their professional perspectives and generated important knowledge of violence risk screening practices. Conclusions The findings affirm the importance of interdisciplinary cooperation in addressing violence risk in the ED and emphasize the need for ongoing clinical education and feedback as well as the importance of optimizing efficiency.

SUICIDE RISK SCREENING SCALES

Introduction: The World Health Organization (WHO) defined suicide as a deliberate act performed by a person who is fully aware of, or hopes for, its fatal outcome. According to the WHO, suicide accounts for 804,000 deaths worldwide and was considered a public health problem. However, suicide could be prevented by well-timed, evidence-based and often inexpensive interventions.In Morocco, the WHO estimated suicide rate of 7.3 per 100,000 inhabitants per year in 2019. However, there was a great lack of scientific and epidemiological data on this subject, hence the importance of early screening and psychometric evaluation. Objective: The purpose of our work was to provide the clinician with a non-exhaustive list of different scales used internationally to screen and assess suicidal risk. Method: This review of the literature used the following databases: PubMed science direct psychinfo. We used the following key words: scale, suicide risk screening. Discussion: Of the 9 tools listed above to assess suicidal risk, the two most frequently mentioned and used scales were the: Beck Scale for Suicide Ideation and The Columbia Suicide Severity Rating Scale (C-SSRS), despite the fact that they were not free of charge and had flaws in their structure (Andreotti ET 2020).the MINI suicide risk module (kadri, 2020) was the only validated scale in Arabic, in addition to being brief and free of charge. Other scales are available free of charge, notably the modified SAD PERSON Scale, the DUCHER scale, the suicide probability scale and the P4 screener. Conclusion: This review allowed us to list the screening scales for suicidal risk, in particular the SIDAS, P4, MINI SR module, DUCHER, BSS, CSSRs. The study helped creating a toolbox that might facilitate the task of clinicians in aim of early diagnosis and appropriate care.

Impact of the COVID-19 pandemic on suicidal attempts and death rates: a systematic review

BackgroundThe COVID-19 pandemic has exacerbated the risk factors associated with suicidal behavior and thus, prioritizing its prevention is recommended.MethodsThis study systematically reviewed the global evidence on the incidence of suicide/suicidal attempts and the trend in suicidal rates during the COVID-19 pandemic. Cross-sectional and cohort studies investigating the outcomes of suicidal death and suicidal attempts at any setting during the COVID-19 pandemic were searched in Medline, Embase, and PsycINFO databases for papers published from December 2019 to May 2021.ResultsOut of 1052 studies18 studies with 12,746 suicidal attempts and 33,345 suicidal deaths were included in the final analysis. The mental health impact of social distancing, COVID-19 quarantine, and financial crises due to loss of employment were associated risk factors with suicide and/or suicidal attempts during the COVID-19 pandemic. Six common thematic recommendations for preventing suicidal deaths and suicidal attempts were identified.ConclusionsUnexpected behavior changes during the COVID-19 pandemic may have contributed to the increasing trend of suicidal attempts reported. Domestic conflicts and violence, financial loss, anxiety and depression, and pre-existing mental health condition/s should be considered in preventing suicidal attempts and deaths secondary to the COVID 19 pandemic. Early detection and timely intervention for individuals with suicidal behavior is crucial and collated recommendations in the current study can be utilized for those preventive interventions. More systematic suicide risk screening process should be introduced who are at risk, along with an evidence base prevention approach.

Improving assessments and follow-up for pediatric emergency department mental health visits

Background: Over the past decade, the number of children presenting to emergency departments (ED) with mental health (MH) concerns has increased substantially. EDs struggle to respond to this increase with approaches that comprehensively address patient needs. The lack of standardized processes to perform risk stratification, assess severity, and ensure access to follow-up care pose barriers to the provision of safe MH care. Our team addressed this gap by introducing an evidence-based care bundle to Alberta’s two pediatric EDs. This report presents the quality improvement (QI) approach used to ensure fidelity of implementation at one of the EDs. This initiative was funded by Alberta Innovates (Partnership for Research and Innovation in the Health System; PRIHS).&#x0D; Methods: We used the Model for Improvement to test and implement each bundle element: suicide risk screening (Ask Suicide-Screening Questions [ASQ]) at ED triage; a tool (HEADS-ED) to streamline and standardize MH assessments by ED-based MH nurse); and an urgent, single-session ‘Choice Appointment’ with a MH professional within 96 hours of the ED visit for patients lacking access to appropriate and timely MH follow-up care. The two ED-based bundle elements did not require additional resources or funding and are expected to reduce length of stay. The follow-up clinic option for ED patients without resources is intended to prevent crisis escalation and match patients with supports. Each new practice was introduced sequentially over a 2-week period. For each practice, we identified 1 to 2 improvement aims, developed key driver diagrams, and selected primary outcomes and measures. Each practice was implemented using Plan-Do-Study-Act (PDSA) cycles with initial tests of change starting small and becoming larger as learning accrued from previous cycles. Our QI team included families with lived experience, patient care and unit managers, nurse educators, frontline healthcare providers, content experts, and clinical leaders who supported staff and led change management strategies. A nurse was hired as a QI lead to support execution of PDSA cycles. We developed a sustainability plan which included embedding education regarding new practices in new healthcare staff orientation, having a measurement strategy to ensure that improvement was maintained, and planning for transition of responsibility for these processes to operational and medical leadership. &#x0D; Evaluation Methods: Primary aims included: 80% of targeted patients would receive the ASQ and HEADS-ED and 100% of children eligible for an Urgent, single-session ‘Choice Appointments’ would be offered it within 96 hours. We used clinical data from the electronic health record (Epic/Connect Care) as well as patient experience data collected via parent/caregiver surveys to determine if the aims for each practice were achieved. We included balancing measures to test whether changes in care in one part of the system introduced unintended consequences in other parts. We evaluated results for the primary aims using run charts to rapidly detect change according to established rules for detecting special cause. We discussed the results from each PDSA cycle in the context of existing healthcare resources to support implementation of each element of the bundle.&#x0D; Results: Tests of change to introduce suicide risk screening began February 1st, 2021. Performance was measured in weekly intervals. The median initial use of ASQ by triage nurses was with 77% of MH patients (686/901 patients), and over time, improved to 93% (319/350 patients), with special cause (shift) in noted September 2021. Tests of change to introduce the HEADS-ED tool began February 16th, 2021. Initial use of the HEADS-ED by MH nurses was 81% (440/555) and improved to 87% (201/227) with special cause (shift) noted August 2021. Urgent, single-session ‘Choice Appointments’ were offered to all patients who did not have timely and access to urgent follow-up with an existing mental healthcare provider with 89.1% having an appointment booked within 96 hours of the ED visit (139/156).&#x0D; Advice and Lessons Learned: Three plans were viewed as crucial to the success of this initiative: 1) a robust strategy to develop proposed changes based on best evidence combined with patient and staff engagement; 2) a comprehensive QI strategy to test, measure, and implement changes; and 3) regular communication and collaboration among ED staff, mental healthcare staff, patients/families, and hospital leadership. There were also lessons learned regarding what could have further enhanced project success: 1) enhanced communication strategies using multiple methods to ensure that project communications reached all stakeholders, including those not regularly present in the ED; 2) hiring the QI lead earlier to begin change management prior to bundle implementation; and 3) outlining a transition plan for clinical data management and bundle monitoring earlier to ease the QI transition to clinical leadership.

Weighing the Costs and Benefits of Universal Suicide Risk Screening in Primary Care: An Evidence-Based Approach.

Back to table of contents Previous article Next article Controversies in Psychiatric ServicesNo AccessWeighing the Costs and Benefits of Universal Suicide Risk Screening in Primary Care: An Evidence-Based ApproachCraig J. Bryan, Psy.D., A.B.P.P., Michael H. Allen, M.D., Charles W. Hoge, M.D.Craig J. BryanSearch for more papers by this author, Psy.D., A.B.P.P., Michael H. AllenSearch for more papers by this author, M.D., Charles W. HogeSearch for more papers by this author, M.D.Published Online:11 Jul 2022https://doi.org/10.1176/appi.ps.202100611AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail View article Access content To read the fulltext, please use one of the options below to sign in or purchase access. Institutional Login Sign in via OpenAthens Purchase Save for later Item saved, go to cart PPV Articles - Psychiatric Services $35.00 Add to cart PPV Articles - Psychiatric Services Checkout Please login/register if you wish to pair your device and check access availability. Not a subscriber? Subscribe Now / Learn More PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development. Need more help? PsychiatryOnline Customer Service may be reached by emailing [email protected] or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.). FiguresReferencesCited byDetailsCited byNone Volume 74Issue 1 January 01, 2023Pages 79-81 Metrics KeywordsRisk screeningSuicideSelf-destructive behaviorPrimary careUniversal screeningPDF download History Published online 11 July 2022 Published in print 1 January 2023

Women Veterans' Perspectives on Suicide Prevention in Reproductive Health Care Settings: An Acceptable, Desired, Unmet Opportunity.

Women veterans of reproductive age experience a suicide rate more than double their civilian peers. Developing effective suicide prevention strategies for women veterans requires identifying settings frequented by women veterans where acceptable prevention initiatives can be implemented. Reproductive health care (RHC) settings may provide such an opportunity. We conducted semi-structured interviews with 21 cisgender women veterans of reproductive age using RHC services provided or paid for by the Department of Veterans Affairs (VA) to understand their beliefs, attitudes, and preferences regarding suicide risk assessment and prevention within these settings. Interview analysis was inductive and used a thematic analysis framework. Four major themes emerged from the interviews: 1) positive patient-provider relationships in RHC settings are important; 2) some women veterans prefer women providers for RHC and suicide risk screening; 3) women veterans' experiences with VA suicide risk screening and assessment vary; and 4) suicide risk screening and prevention in RHC settings is a desired and acceptable, yet unmet opportunity. Findings from this novel study suggest that VA RHC settings may present a viable milieu for implementing upstream, gender-sensitive, veteran-centric suicide prevention strategies. Future research is needed with VA RHC providers to determine their needs for successfully implementing such strategies.

Scores on the suicide cognitions scale-revised (SCS-R) predict future suicide attempts among primary care patients denying suicide ideation and prior attempts

BackgroundApproximately half of patients who attempt or die by suicide screened negative for suicidal ideation during their most recent medical visit. Maladaptive beliefs and schemas can increase cognitive vulnerability to suicidal behavior, even among patients without recent or past suicidal thoughts and behaviors. Assessing these beliefs could improve the detection of patients who will engage in suicidal behavior after screening negative for elevated suicide risk. MethodsPrimary care patients who completed the Patient Health Questionnaire-9 and the Suicide Cognitions Scale-Revised (SCS-R) during routine clinic visits and denied suicidal ideation at baseline (N = 2417) were included in the study sample. Suicidal behaviors during the 12 months after baseline were assessed. Logistic regression analyses examined the association of baseline SCS-R scores with later suicidal behavior. ResultsIn both univariate and multivariate analyses, SCS-R total scores were associated with significantly increased risk of suicidal behavior within 90, 180, and 365 days post-baseline. Results were unchanged when patients who reported prior suicidal behavior were excluded (N = 2178). In item-level analyses, all 16 SCS-R items significantly differentiated patients with and without follow-up suicidal behavior. LimitationsStudy limitations included missing follow-up data, restriction of sample to U.S. military medical beneficiaries, and inability to assess representativeness of the sample relative to the full primary care population. ConclusionsSCS-R scores are elevated among patients who attempt suicide after denying both suicidal ideation and prior suicide attempts, suggesting the scale may reflect enduring suicide risk. The SCS-R could enhance suicide risk screening and assessment.

We Must Continue Screening Youth For Suicide Risk

We Must Continue Screening Youth For Suicide Risk

Getting to the Root of the Problem: A Decision-Tree Analysis for Suicide Risk Among Young People Experiencing Homelessness

Objective: Although many suicide risk factors have been identified, there is limited guidance about their relative importance and the combinations of factors that heighten risk among young people experiencing homelessness (YEH). We sought to use decision-tree (DT) analyses to better understand and predict suicidal ideation and suicide attempts among YEH. Method: Using survey and social network methods, we gathered information about 940 YEH and their relationships. We then used a machine learning approach to construct classification and regression tree models to predict suicidal ideation and suicide attempts. Results: Thirteen variables were important correlates in the DT models; this included prominent individual risk factors (e.g., trauma, depression), but more than half were social network factors (e.g., hard drug use). For suicidal ideation, the model had an area under the receiver operating characteristic curve (AUC) value of 0.79, with accuracy of 68%, sensitivity of 48%, and specificity of 73%. For suicide attempt, the model had an AUC value of 0.86, with accuracy of 71%, sensitivity of 68%, and specificity of 72%. Conclusions: Effective suicide prevention programming should target the syndemic that threatens YEH (i.e., co-occurrence of trauma, depression, substance use, and violence), including social norms in their environments. With refinement, our decision trees may be useful for suicide risk screening and guiding targeted intervention.

Association between headache and suicidality: An analysis of universal suicide screening data at a large urban county hospital

Identifying individuals at increased risk of suicide is important, particularly those who present for treatment for nonpsychiatric chief complaints who may go undetected. It has been found that pain symptoms, such as headache, are associated with suicide, although this association requires further characterization. This study examined specific components of suicidality in relation to headache subtypes. This study retrospectively reviewed 2,832,835 nonpsychiatric adult clinical encounters at a large county hospital, where a standardized suicide risk screening tool, the Columbia-Suicide Severity Rating Scale (C-SSRS), was universally implemented. The C-SSRS assesses specific components of suicidality: wish to be dead and suicidal ideation, method, intent, plan, and action. Multivariate logistic regressions were performed to assess the association between headache, as well as headache subtype (migraine, tension, or cluster), and each component of suicidality. There were significant positive associations between presenting with a headache and 2 specific components of suicidality: wish to be dead and suicidal action. Individuals with tension headache may have a lower risk of wishing to be dead compared to those with migraine and cluster headaches. The association of headaches with specific elements of sui-cidality demonstrates the potential yield of identification of suicide risk among individuals with nonpsychiatric presentations.

Anxiety and Suicide Risk Among Youths in the Emergency Department

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