87. Teen Suicide Screening: Why Depression Screening Isn't Enough

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Depression screening and suicide screening are not the same thing—and relying on the PHQ-9 alone can miss youth who are at risk for suicide.

In this episode, I break down a quick, practical approach to suicide screening and risk assessment in primary care —including what to do when a screening tool comes back positive.

In this episode, you’ll learn:

• 🚨 Why the PHQ-9 isn’t enough — and how many at-risk youth can slip through the cracks when you rely on depression screening alone.
• 🔎 Who deserves extra attention — including youth with ADHD, anxiety, depression, substance use, trauma, self-harm, or a family history of suicide.
• 📝 The quick, free screening tool I recommend — the ASQ (Ask Suicide-Screening Questions), which can be used alongside your usual depression screener.
• 🧭 What to do when the suicide screen is positive — without automatically sending every child to the ER.
• 🚦 The 4-step framework for deciding: ER or outpatient?
  1. Ask about current suicidal thoughts
  2. Assess plan, intent, and previous attempts
  3. Check whether the child can be safe at home
  4. Decide whether they need emergency evaluation or outpatient management
• 🏠 The two home-safety questions you should always ask before sending a higher-risk child home.
• 💡 How to make suicide screening actually work in a busy pediatric practice without adding another impossible-to-manage task to your day.

The big takeaway:
Depression screening ≠ suicide screening. Adding a brief, validated suicide screening tool can help you identify kids who might otherwise be missed—and give you a structured way to decide what to do next.

Resources mentioned

• ASQ (Ask Suicide-Screening Questions) Toolkit, including the PHQ-9 + ASQ screening tool available athttps://www.nimh.nih.gov/research/research-conducted-at-nimh/asq-toolkit-materials
• Brief Suicide Safety Assessment Worksheet 
• https://www.nimh.nih.gov/research/research-conducted-at-nimh/asq-toolkit-materials/youth-asq-toolkit#outpatient

24/7 National Suicide Prevention Lifeline   1-800-273-TALK (8255)

En Español: 1-888-628-9454

24/7 Crisis Text Line: Text “HOME” to 741-741

References

Horowitz LM et al. Screening Pediatric Medical Patients for Suicide Risk: Is Depression Screening Enough? J Adolesc Health. 2021 Jun;68(6):1183-1188.

Kemper AR et al. Depression and Suicide-Risk Screening Results in Pediatric Primary Care. Pediatrics. 2021 Jul;148(1):e2021049999.

Kim Y, Krause TM, Lane SD. Trends and Seasonality of Emergency Department Visits and Hospitalizations for Suicidality Among Children and Adolescents in the US from 2016 to 2021. JAMA Netw Open. 2023 Jul 3;6(7):e2324183.

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