Am Fam Physician. 2005 Nov 15;72(10):2120.
Various suicide screening tests for adolescents exist, with sensitivities ranging from 75 to 100 percent. Although school-based screening tests seem to identify adolescents at risk, the harms of screening are unknown. Gould and colleagues assessed potential harms of screening, focusing particularly on whether screening creates distress or promotes suicidal ideation among adolescents.
The study involved 2,342 students 13 to 19 years of age from six schools, who were divided into two groups: one experimental and one control. Both groups completed a survey, but only the experimental group’s survey included questions about suicide. In a second survey, administered two days later, all students were asked questions about suicidality. The surveys included a mood questionnaire (Profile of Mood States adolescent version, or POMS-A) and questions about suicide ideation, depression, suicide attempt history, and substance abuse.
Neither levels of distress nor depressive feeling differed between the groups after the first survey; rates of depressive feelings were 13.3 percent in the experimental group and 11 percent in the control group. Suicidal ideation did not differ between the two groups after the first survey or in response to the second survey. Students with depressive symptoms, as measured by a cutoff score on a depression scale, reported more distress and suicidal ideation than the students without depression, but there was no difference between these students when comparing the experimental and control groups. Among those who reported suicide attempts, there was less suicidal ideation reported in the experimental group. Students who abused substances were more depressed and had more suicidal ideation than those who did not, but group allocation affecting these interactions did not reach statistical significance.
Studies have shown that some school-based suicide prevention programs have no benefit and may cause harm. Gould and colleagues, however, found that the deleterious effects of such educational programs do not apply to screening programs, and that screening might be beneficial to students with suicidal ideation. The authors conclude that suicide screening should remain at the forefront of screening programs, and fears that the screening process itself will increase distress or trigger suicidal behavior are misplaced.
Gould MS, et al. Evaluating iatrogenic risk of youth suicide screening programs: a randomized controlled trial. JAMA. April 6, 2005;293:1635-43.
Copyright © 2005 by the American Academy of Family Physicians.
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