Suicide Screening in Primary Care: Use of an Electronic Screener to Assess Suicidality and Improve Provider Follow-Up for Adolescents

Dillon J. Etter, Allison McCord, Fangqian Ouyang, Amy Lewis Gilbert, Rebekah Williams, James A. Hall, Wanzhu Tu, Stephen Downs, Matthew Aalsma

Research output: Contribution to journalArticle

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Abstract

Purpose: The purpose of this study was to assess the feasibility of using an existing computer decision support system to screen adolescent patients for suicidality and provide follow-up guidance to clinicians in a primary care setting. Predictors of patient endorsement of suicidality and provider documentation of follow-up were examined. Methods: A prospective cohort study was conducted to examine the implementation of a CDSS that screened adolescent patients for suicidality and provided follow-up recommendations to providers. The intervention was implemented for patients aged 12-20 years in two primary care clinics in Indianapolis, Indiana. Results: The sample included 2,134 adolescent patients (51% female; 60% black; mean age = 14.6 years [standard deviation = 2.1]). Just over 6% of patients screened positive for suicidality. A positive endorsement of suicidality was more common among patients who were female, depressed, and seen by an adolescent-medicine board-certified provider as opposed to general pediatric provider. Providers documented follow-up action for 83% of patients who screened positive for suicidality. Documentation of follow-up action was correlated with clinic site and Hispanic race. The majority of patients who endorsed suicidality (71%) were deemed not actively suicidal after assessment by their provider. Conclusions: Incorporating adolescent suicide screening and provider follow-up guidance into an existing computer decision support system in primary care is feasible and well utilized by providers. Female gender and depressive symptoms are consistently associated with suicidality among adolescents, although not all suicidal adolescents are depressed. Universal use of a multi-item suicide screener that assesses recency might more effectively identify suicidal adolescents.

Original languageEnglish (US)
JournalJournal of Adolescent Health
DOIs
StateAccepted/In press - Jan 1 2017

Fingerprint

Suicide
Primary Health Care
Documentation
Adolescent Medicine
Hispanic Americans
Cohort Studies
Prospective Studies
Depression
Pediatrics

Keywords

  • Adolescent
  • CDSS
  • Primary Care
  • Screening
  • Suicide

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Public Health, Environmental and Occupational Health
  • Psychiatry and Mental health

Cite this

Suicide Screening in Primary Care : Use of an Electronic Screener to Assess Suicidality and Improve Provider Follow-Up for Adolescents. / Etter, Dillon J.; McCord, Allison; Ouyang, Fangqian; Gilbert, Amy Lewis; Williams, Rebekah; Hall, James A.; Tu, Wanzhu; Downs, Stephen; Aalsma, Matthew.

In: Journal of Adolescent Health, 01.01.2017.

Research output: Contribution to journalArticle

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abstract = "Purpose: The purpose of this study was to assess the feasibility of using an existing computer decision support system to screen adolescent patients for suicidality and provide follow-up guidance to clinicians in a primary care setting. Predictors of patient endorsement of suicidality and provider documentation of follow-up were examined. Methods: A prospective cohort study was conducted to examine the implementation of a CDSS that screened adolescent patients for suicidality and provided follow-up recommendations to providers. The intervention was implemented for patients aged 12-20 years in two primary care clinics in Indianapolis, Indiana. Results: The sample included 2,134 adolescent patients (51{\%} female; 60{\%} black; mean age = 14.6 years [standard deviation = 2.1]). Just over 6{\%} of patients screened positive for suicidality. A positive endorsement of suicidality was more common among patients who were female, depressed, and seen by an adolescent-medicine board-certified provider as opposed to general pediatric provider. Providers documented follow-up action for 83{\%} of patients who screened positive for suicidality. Documentation of follow-up action was correlated with clinic site and Hispanic race. The majority of patients who endorsed suicidality (71{\%}) were deemed not actively suicidal after assessment by their provider. Conclusions: Incorporating adolescent suicide screening and provider follow-up guidance into an existing computer decision support system in primary care is feasible and well utilized by providers. Female gender and depressive symptoms are consistently associated with suicidality among adolescents, although not all suicidal adolescents are depressed. Universal use of a multi-item suicide screener that assesses recency might more effectively identify suicidal adolescents.",
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