Using Behavioral Measures to Assess Suicide Risk in the Psychiatric Emergency Department for Youth

Ki Eun Shin; Argelinda Baroni; Ruth S Gerson; Kerri-Anne Bell; Olivia H Pollak; Katherine Tezanos; Anthony Spirito; Christine B Cha

doi:10.1007/s10578-023-01507-y

Using Behavioral Measures to Assess Suicide Risk in the Psychiatric Emergency Department for Youth

Child Psychiatry Hum Dev. 2023 Feb 23. doi: 10.1007/s10578-023-01507-y. Online ahead of print.

Authors

Ki Eun Shin¹, Argelinda Baroni², Ruth S Gerson², Kerri-Anne Bell³, Olivia H Pollak⁴, Katherine Tezanos⁵, Anthony Spirito⁵, Christine B Cha⁶

Affiliations

¹ Department of Behavioral Sciences, Long Island University, Post Campus, Brookville, NY, USA.
² Department of Child and Adolescent Psychiatry, New York University Grossman School of Medicine, New York, NY, USA.
³ Department of Psychology, University of Notre Dame, Notre Dame, IN, USA.
⁴ Department of Psychology and Neuroscience, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
⁵ Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.
⁶ Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, NY, USA. cbc2120@tc.columbia.edu.

PMID: 36821015
DOI: 10.1007/s10578-023-01507-y

Abstract

Suicide screening is critical in pediatric emergency departments (EDs). Behavioral measures of suicide risk may complement self-report measures. The current study examines suicide-specific behavioral measures and tests their potential short-term within-person effects among respondents, ability to discriminate future suicide attempt from suicidal ideation, and translation into interpretable categorical composite scores. The sample included 167 youth (10-17 years), presenting for suicide-related reasons to a pediatric psychiatric ED. During their ED visit, participants completed the Death/Life Implicit Association Test (IAT) and the Suicide Stroop Task. Recurrent suicidal thoughts and attempts were assessed within 6 months of the ED visit via medical records and email surveys. Youth displayed a decrease in the levels of distress and self-injurious desires (negative mood, desire to hurt themselves, and desire to die) after completing the behavioral tasks. The Death/Life IAT prospectively differentiated with 68% accuracy between youth who attempted suicide after their ED visit and those who had suicidal ideation but no attempt, p = 0.04, OR = 5.65, although this effect became marginally significant after controlling for self-report and demographic covariates. Neither the Suicide Stroop Task, nor the categorical composite scores predicted suicide attempts, ps = 0.08-0.87, ORs = 0.96-3.95. Behavioral measures of suicide risk administered in the ED do not appear to increase distress or self-injurious desires. They may be able to distinguish those who go on to attempt suicide (vs. consider suicide) within six months after discharge.

Keywords: Emergency department; Emotional stroop task; Implicit association test; Suicide; Youth.

Grants and funding

YIG-2-026-16/American Foundation for Suicide Prevention