Evaluating Iatrogenic Risk of Youth Suicide Screening Programs

TLDR

Increased youth suicide screening is mandated by recent legislation, yet the potential iatrogenic harm of such programs remains unstudied despite widespread adoption. The study evaluated 2,004 adolescents from eight New York metropolitan sites to assess the impact of suicide screening. Screening tools such as the Suicidal Ideation Questionnaire and the Suicide Risk Screen showed high sensitivity (83–100%) but moderate specificity (49–70%) in school settings.

Abstract

Commission 1 and the Children's Mental Health Screening and Prevention Act 2 recommend increased screening for suicidality and mental illness.The recent enactment of the Garrett Lee Smith Memorial Act 3 further supports the development of youth suicide prevention and intervention programs.Despite the proliferation of screening programs in recent years (eg, Signs of Suicide, 4 Teen-Screen 5 ), the current debate about possible iatrogenic effects of other suicide preventive interventions, 6,7 and the belief that prevention programs may "spur troubled youngsters to try suicide," 8 the potential harm of screening for suicide remains unstudied. 9,10creening strategies are based on the valid premise that suicidal adolescents are underidentified [11][12][13][14][15] ; have an active, often treatable, mental illness [16][17][18] ; and exhibit identifiable risk factors. 11Evidence for the clinical validity and reliability of school-based screening procedures has recently emerged.Use of the Suicidal Ideation Questionnaire (SIQ) in a midwestern US high school yielded a sensitivity ranging from 83% to 100%, with specificity from 49% to 70%. 19The Suicide Risk Screen's use among 581 students in 7 high schools had a sensitivity ranging from 87% to 100%, with specificity from 54% to 60%. 20Among 2004 teenagers from 8 New York metropoli-