Asking preadolescents about suicide doesn’t enhance suicidal ideas

One of many important considerations about asking preadolescents (8-12 yr olds) about suicidal ideas is the worry that it’s going to really trigger or enhance suicidal ideas (i.e, have an iatrogenic impact). As a result of preadolescence is a time of speedy cognitive growth, the place younger folks could also be extra suggestible, it has been proposed that asking or speaking to them about delicate matters like suicide may trigger misery and introduce concepts that that they had not beforehand thought-about (Ayer et al., 2020). This makes folks hesitant to ask preadolescents about suicidal ideas, each in analysis and in follow.

Nevertheless, one evaluation discovered that round one in 13 kids youthful than 12 years outdated expertise suicidal ideation (learn extra in a current weblog by Rasanat and Mahmoud). This introduces a medical dilemma: avoiding the subject might really feel protecting however by failing to ask, you danger not providing help to kids who’re already scuffling with suicidal ideas.

Encouragingly, there may be proof to recommend early identification of suicidal ideas and applicable intervention could be efficient in decreasing danger on this age group (Colizzi et al., 2020). With this in thoughts, Hennefield and colleagues (2026) examined whether or not there are any iatrogenic results of suicide screening in two teams of preadolescents; these with no reported historical past of suicidal ideas (lower-risk) and people with a historical past of suicidal ideas (higher-risk). Particularly, they aimed to search out out if repeated screening was related to new suicidal ideas within the lower-risk group and a rise in suicidal ideas for the higher-risk group.

Clinicians face a dilemma: avoiding asking preadolescents about suicidal ideas might really feel safer as a result of it reduces the danger of inflicting misery, however not asking might imply lacking the chance to offer help.

Strategies

The research adopted preadolescents from Missouri who had beforehand taken half in analysis evaluating psychotherapy for preschool-onset main depressive dysfunction (PO-MDD). At baseline, contributors and their caregivers accomplished an in-person structured psychiatric interview to evaluate suicidal ideas and have been separated into two teams: lower-risk and higher-risk.

Over the subsequent 12 months, contributors accomplished an tailored on-line model of the Ask Suicide-Screening Questions (ASQ; Horowitz et al., 2012). Decrease-risk contributors accomplished it month-to-month, whereas higher-risk contributors accomplished it weekly. The tailored instrument included three objects concerning the previous week (wishing to be lifeless, feeling others could be higher off in the event that they have been lifeless, and ideas of killing themselves), with the authors including a fourth merchandise to evaluate present intent. Any “sure” response was counted as a optimistic display screen.

Analyses used Pearson correlations and hierarchical generalised linear fashions, controlling for age and intercourse, to check whether or not repeated screening elevated suicidal ideas. Bayes issue evaluation examined the meaningfulness of the null impact, and additional sensitivity analyses have been completed on lower-risk contributors to take away preadolescents with any historical past of PO-MDD, as PO-MDD strongly predicts suicidal ideas in adolescents.

Outcomes

General, 192 preadolescents agreed to participate and accomplished at the very least one ASQ survey. The imply age of contributors was 10.13 years outdated (SD = 1.02) and 79.2% of the contributors have been White. Within the lower-risk group (n = 68), 98.4% of the screens throughout the 12 months have been unfavorable and just one.6% have been optimistic. For the higher-risk group (n = 124) throughout the 12 months, 93% of screens have been unfavorable and seven% have been optimistic.

Decrease-risk group

Analyses discovered:

• No relationship between what number of ASQ surveys have been accomplished and what number of have been optimistic screens (r = 0.16, p = .192) which means that there was no cumulative impact of finishing the screening on growing suicidal ideas.
• No proof that the survey week (i.e., what number of occasions a preadolescent was requested about suicidal ideas) predicted the possibilities of a optimistic display screen (i.e., extra experiences of suicidal ideas) (OR = 1.04, 95% CI [1.00 to 1.09], p = .067) even when controlling for intercourse at start and within-subject age.
• No proof that finishing the survey in a single month predicted the chance of a optimistic display screen within the subsequent month (OR = 0.40, 95% CI [0.07 to 2.19], p = .288), together with when intercourse at start and within-subject age was managed for.

A Bayes issue evaluation supported the null findings, and outcomes from the sensitivity evaluation have been much like the first evaluation, reinforcing that there is no such thing as a proof that repeat ASQ screening will increase optimistic screenings for suicidal ideas, even when eradicating the potential confounding issue of early melancholy historical past.

Greater-risk group

The findings have been the identical for the higher-risk preadolescent group who acquired the ASQ weekly:

• No important affiliation between survey completion charges and optimistic screenings (r = 0.11, p = .242).
• Survey week didn’t predict optimistic screens (OR = 0.99, 95% CI [0.98 to 1.00], p = .160)
• No relationship between finishing the survey one week and the possibilities of a optimistic display screen the next week (OR = 0.93, 95% CI [0.59 to 1.47], p =.756).

These outcomes have been additionally supported by the Bayes issue evaluation confirming that there was no dangerous impact of repeated ASQ screening on this group of preadolescents.

Repeated suicide screening was not related to iatrogenic results in preadolescents with and with out a historical past of suicidal ideas.

Conclusion

General, this research discovered preliminary proof to recommend that repeated suicide screening shouldn’t be related to an elevated chance of suicidal ideas in preadolescents with and with out a historical past of suicidal ideas. There was no proof to recommend that the extra screenings preadolescents accomplished, the upper the chance of them having a optimistic display screen, nor that finishing a screening one week/month elevated the chance of a optimistic display screen the subsequent week/month. The authors concluded that, whereas there are justifiable considerations about asking preadolescents about suicidal ideas:

Findings recommend that funders, investigators, mother and father, and youth can really feel extra assured about youth collaborating and contributing to this critically wanted analysis. Findings additionally recommend that clinicians can proceed with screening in kids on this age group with confidence that the advantages outweigh the dangers.

Findings from this research recommend that it’s comparatively protected to ask preadolescents about suicidal ideas within the context of psychological well being analysis, which can switch to medical settings.

Strengths and limitations

Strengths

• The mixture of various statistical exams used by the authors (i.e., hierarchical fashions, Bayes elements) strengthens the interpretation of the research findings, growing our confidence that there is no such thing as a impression of repeated ASQ screening on suicidal ideas on this inhabitants.
• The authors used a longitudinal design to comply with preadolescents throughout a 12-month interval. That is vital as a result of suicidal ideas can fluctuate, which means a single measurement might have misrepresented precise danger; as such, this will increase the reliability of the findings.
• Outcomes have been based mostly on information from the ASQ, which is a validated instrument with sturdy psychometric properties. This will increase our confidence that the research really measured suicidal ideas, and that this was completed in a constant and dependable manner.
• The completion charges for the ASQ screenings have been excessive (~75-75%) which means that the info is prone to be dependable and consultant for this pattern. This additionally signifies that common suicide-risk screening is possible and acceptable for preadolescents.

Limitations

• A lot of the pattern have been White, which limits the generalisability of the findings to different extra various teams. That is notably vital, as proof suggests there’s a increased suicide danger and price amongst minority ethnic youth in contrast with White youth (Alvarez et al., 2022), which can be related to suicide-risk screening.
• Equally, a number of the cohort used on this research had beforehand undergone psychotherapy for PO-MDD. Whereas sensitivity analyses addressed the confounding issue of PO-MDD historical past, it’s unclear what impression the intervention and former publicity to the subject of suicidal ideas might have had.
• Relatedly, many probably confounding elements weren’t included within the evaluation which can have had an impression, such a life occasions (e.g., lack of a beloved one, mum or dad divorce).
• Whereas the present intent merchandise that was added to the ASQ was vital for the research’s function, it’s unclear whether or not this adaptation might have affected the questionnaire’s validity, thus making the findings untrustworthy.

Whereas using a validated measure of suicide danger is a power of the research, it’s unclear what impression the authors’ diversifications had on its psychometric properties and total reliability.

Implications for follow

Findings from this research appear to help that for this pattern, repeatedly asking about suicidal ideas throughout 12 months doesn’t enhance suicidal ideas prevalence. Though these findings are preliminary, with the authors emphasising that they “need to watch out about claiming no danger for youth when partaking in suicide-risk screening”, it might assist to alleviate considerations round asking preadolescents about suicidal ideas. Not solely may this make it extra possible for researchers to conduct vital analysis associated to suicidal ideas and behaviours, but it surely additionally might assist clinicians to really feel extra assured in proactively asking about suicidal ideas. This might lead to earlier identification of suicidal ideas and extra wrap-around look after these in want, which might be essential in decreasing suicide danger for this inhabitants. Dad and mom and carers will also be reassured that there’s restricted danger in preadolescents collaborating in one of these analysis or probably being requested these questions by clinicians.

Nevertheless, some warning continues to be wanted as a result of lack of readability whether or not these findings could be relevant throughout totally different populations and settings. Future analysis ought to embrace preadolescents from totally different racial and ethnic backgrounds, as effectively at those that have by no means acquired any psychological well being help. Moreover, the ASQ asks about suicidal ideas over the previous week; future analysis might think about using strategies corresponding to ecological momentary evaluation (EMA) to seize suicidal ideas in actual time and see if there are any iatrogenic results on this format, as there might be distinction.

There’s additionally a wider dialog available round how clinicians ought to display screen for suicidal ideas. Younger folks have expressed unfavorable views about having their suicidal danger being assessed utilizing danger evaluation instruments as they discover these rigid and non-holistic, with the potential to invalidate somebody’s emotions if the end result doesn’t match their expertise (Bellairs-Walsh et al., 2020). Clinicians have additionally expressed fears that utilizing danger evaluation instruments might lead to inappropriate or missed referrals and impression their rapport with sufferers as a result of questions on assessments typically being blunt and insensitively phrased (Michail et al., 2015). Additional qualitative analysis might be used to discover preadolescents’ perceptions and views of being repeatedly administered the ASQ screener, which might present additional perception into the present research’s findings.

Future research might lengthen this analysis to see if extra frequent screening, corresponding to day by day diaries or ecological momentary evaluation, is equally protected on this inhabitants.

Assertion of pursuits

Kayley McPherson has no battle of curiosity to reveal.

Edited by

Dr Nina Higson-Sweeney.

Hyperlinks

Main paper

Laura Hennefield, Katherine R. Luking, Rebecca Tillman, Deanna M. Barch, Joan L. Luby, & Renee J. Thompson (2026). Asking preadolescents about suicide shouldn’t be related to elevated suicidal ideas. Journal of the American Academy of Little one & Adolescent Psychiatry, 65(1), 34–41. https://doi.org/10.1016/j.jaac.2025.03.025

Different references

Alvarez, Ok., Polanco-Roman, L., Samuel Breslow, A., & Molock, S. (2022). Structural racism and suicide prevention for ethnoracially minoritized youth: a conceptual framework and illustration throughout programs. American Journal of Psychiatry, 179(6), 422-433. https://doi.org/10.1176/appi.ajp.21101001

Ayer, L., Colpe, L., Pearson, J., Rooney, M., & Murphy, E. (2020). Advancing analysis in little one suicide: A name to motion. Journal of the American Academy of Little one & Adolescent Psychiatry, 59(9), 1028-1035. https://doi.org/10.1016/j.jaac.2020.02.010

Bellairs-Walsh, I., Perry, Y., Krysinska, Ok., Byrne, S. J., Boland, A., Michail, M., … & Robinson, J. (2020). Finest follow when working with suicidal behaviour and self-harm in main care: A qualitative exploration of younger folks’s views. BMJ Open, 10(10), e038855. https://doi.org/10.1136/bmjopen-2020-038855

Colizzi, M., Lasalvia, A., & Ruggeri, M. (2020). Prevention and early intervention in youth psychological well being: Is it time for a multidisciplinary and trans-diagnostic mannequin for care? Worldwide Journal of Psychological Well being Techniques, 14(1), 23. https://doi.org/10.1186/s13033-020-00356-9

Horowitz, L. M., Bridge, J. A., Educate, S. J., Ballard, E., Klima, J., Rosenstein, D. L., … & Pao, M. (2012). Ask Suicide-Screening Questions (ASQ): a quick instrument for the pediatric emergency division. Archives of Pediatrics & Adolescent Drugs, 166(12), 1170-1176. https://doi.org/10.1001/archpediatrics.2012.1276

Michail, M., & Tait, L. (2016). Exploring normal practitioners’ views and experiences on suicide danger evaluation and administration of younger folks in main care: A qualitative research within the UK. BMJ Open, 6, e009654. https://doi.org/10.1136/bmjopen-2015-009654

Nawaz, R. F., & Arif, M. (2023). Suicide and self-harm in kids: prevalence charges trigger for concern. The Psychological Elf.

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