Novel Computerised Screening Tool Reliably Predicts Youth Suicide Attempt Within 3 Months

February 4, 2021

The Computerized Adaptive Screen for Suicidal Youth (CASSY) tool, designed to be used in emergency rooms, can reliably predict a youth suicide attempt within 3 months, according to a study published in JAMA Psychiatry.

In an independent validation cohort that included 2,754 adolescents, of which 165 (6%) made at least 1 suicide attempt over the 3-month period, the CASSY predicted risk for suicide attempt with more than 88% accuracy.

“Too many young people are dying by suicide and many at high risk go completely unrecognised and untreated,” said lead author Cheryl King, PhD, University of Medicine, Ann Arbor, Michigan. “About half of the youth who die by suicide have never received any mental health services and some die on their first suicide attempt. We saw an urgent need to improve proactive, universal suicide screening of young people.”

The screening tool is brief and efficient, and doesn’t disrupt care. When an adolescent or teen is admitted for any reason -- whether it’s a psychiatric complaint or something unrelated like a sports injury -- they complete a questionnaire on a digital device. Follow-up questions and the number of questions are based on their answers so that the screening is tailored to the individual patient.

Adolescents are asked about suicidal thoughts but also other factors that may put them at risk, such as sleep disturbance, trouble concentrating, agitation, depression and hopelessness, and issues with family and school connectedness. The combination of risk factors is what determines a score for their suicidal risk level.

While existing suicide screening tools are currently used, previous research indicates that many young people who are high risk still aren’t detected or too many are detected as being at risk, including many who are false positives.

“Different combinations of risk factors can place youth at risk,” said Dr. King. “If we screen only for suicidal thoughts, we will miss some high risk adolescents. There are many reasons young people may not share suicidal thoughts, possibly because they’re ashamed, they aren’t experiencing the thoughts at the time of screening, or someone reacted in a way they didn’t feel was helpful when they shared suicidal thoughts or sensitive information in the past.”

The CASSY system provides the healthcare provider in emergency services with information about the probability of a future suicide attempt. It offers thresholds for identifying different levels of risk, ranging from mild to high.

“This screening tool has the potential to be a step forward in our effort to improve clinical care models to adequately meet the needs of youth mental health,” said Dr. King.

The algorithm for the computerised screening tool was based on data from multiple centres that participated in the Emergency Department Screen for Teens at Risk for Suicide. Two cohorts were used to develop and validate the tool. The first cohort had 2,075 adolescents aged 12 to 17 years, and the independent validation cohort included data from 2,754 adolescents aged 12 to 17 years.

The researchers are hopeful that many emergency departments nationwide will consider incorporating this personalised screening tool into their care models to improve suicide risk identification and treatment planning.

Reference: https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2775993

SOURCE: University of Michigan