TEDMED

Screening Teens for Suicide, With Dr Cheryl King

May 04, 2020

This transcript has been edited for clarity.

Cheryl King, PhD, spoke with MDEdge's Nick Andrews at TEDMED about a suicide risk screen for teens that is based on a computerized algorithm.

Take-home points

  • King is a longtime researcher in teen suicide, and her current project is creating a personalized adaptive suicide risk screen for teens, called CASSY (Computerized Adaptive Screen for Suicidal Youth).

  • In an adaptive algorithm, subsequent questions will change on the basis of the previous answer. The aim is to create a profile of risk factors and warning signs to generate a risk level that will guide the type of mental health interventions required in the emergency department (ED)and beyond.

  • CASSY also is being developed as a universal screen for those who might come to the ED without a mental health history. Many teens who die by suicide have not had previous contact with mental health professionals.

  • More research is being done to create and validate treatment interventions for at-risk teens so that the risk levels generated in the ED can be met with evidence-based interventions for preventing suicide.

  • With the scarcity of mental health resources in some areas, King and associates have created an model that trains youth-nominated adults from within families to intervene in times of crisis.

Summary

  • CASSY is based on computerized algorithms from data collected by the Pediatric Emergency Care Applied Research Network (PECARN). Within this network, thousands of teens in mental health crisis, whether or not they have attempted suicide, have completed a suicide risk survey aimed at modeling specific warning signs and risk factors for predicting suicide attempts in the next 3 months. In an adaptive algorithm, subsequent questions will change on the basis of the previous answer.

  • The risk factors for teen suicide are well established, but teens who attempt are a heterogeneous group. The key to predicting an imminent risk for suicide depends on developing profiles of risk based on how the risk factors and warning signs group together. The result of CASSY is a level of risk. Individual institutions can set their risk levels.

  • CASSY is being developed as a universal screen for those who might come to the ED without a mental health history. Many teens who die by suicide have not had previous contact with mental health professionals. The goal is for CASSY to be integrated into a medical system's EHR in order to make it easier to use in a broad population.

  • The most common intervention for suicide risk in an ED is creating a safety plan that involves identifying warning signs for decompensated mood, brainstorming coping skills, and delineating emergency contacts and a plan of action for suicidal emergency.

  • King and associates developed the Youth-Nominated Support Team intervention, which harnesses the strength of the adults in the family to bolster treatment as usual. The teens nominate "caring adults" who they want to support them after hospitalization, and the adults are provided with psychoeducation and training to more effectively support the teens.

  • King is also working on a National Institute of Mental Health–supported study to identify the 24-hour warning signs for suicide attempts. She believes that there is more work to be done in combining the screening tools with interventions in the ED and beyond.

References

King CA. 4.1 A computerized adaptive screen for suicidal youth (CASSY): development in the Ed Stars national sample. J Am Acad Child Adolesc Psychiatry. 2019;58:S305. Source

King CA, Horwitz A, Czyz E, Lindsay R. Suicide risk screening in healthcare settings: identifying males and females at risk. J Clin Psychol Med Settings. 2017;24:8-20. Source

King CA, Arango A, Kramer A, et al. Association of the youth-nominated support team intervention for suicidal adolescents with 11- to 14-year mortality outcomes: secondary analysis of a randomized clinical trial. JAMA Psychiatry. 2019;76:492-498. Source

King CA, Brent D, Grupp-Phelan J, et al. Five profiles of adolescents at elevated risk for suicide attempts: differences in mental health service use. J Am Acad Child Adolesc Psychiatry. 2019 Dec 9;S0890-8567(19)32222-1. Source

National Institute of Mental Health: ASQ Toolkit for Suicide Screening

Show notes by Jacqueline Posada, MD, associate producer of Psychcast and consultation-liaison psychiatry fellow with the Inova Fairfax Hospital/George Washington University program in Falls Church, Virginia. Posada has no conflicts of interest.

For more MDedge Podcasts, go to mdedge.com/podcasts
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Cheryl A. King, PhD, is a clinical psychologist and professor in the department of psychiatry at Michigan Medicine, the academic health system at the University of Michigan, Ann Arbor. She is the lead author of Teen Suicide Risk: A Practitioner Guide to Screening, Assessment, and Management. King has provided testimony before the US Senate on youth suicide prevention and is a past president of the American Association of Suicidology, the Association of Psychologists in Academic Health Centers, and the Society for Clinical Child and Adolescent Psychology. She is a member of the National Advisory Mental Health Council.

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