Psy-Q: How can screening techniques be improved to help prevent teen suicides?

Answer: Looking at a variety of risk factors can help to better identify those individuals who are at risk for suicide. This goes beyond screening for suicidal ideation and behaviors and can include other risk factors like sleep disturbances, trouble concentrating, depression, and more, which were included in a recent study about a new computerized, adaptive suicide screening tool for youth (CASSY).

Jill Harkavy-Friedman, PhD, a practicing clinical psychologist and vice president of research for the American Foundation for Suicide Prevention (AFSP), who was not involved in the CASSY study, tells Psycom Pro that suicidal ideation in the past or present does not necessarily mean that a person is currently at risk.

“Past ideation and behavior are important components of a risk assessment, but they won’t tell you what the risk is of this person taking their life in the near future. What’s nice about this instrument [the CASSY] is that it also includes other factors and variables that contribute to risk,” explains Dr. Harkavy-Friedman. (More perspectives on the CASSY.)

“We know that suicide is very complex and that it’s always the result of multiple factors coming together in the context of stress,” she adds.

Risk assessment should go beyond just finding out if the person is thinking about suicide, Dr. Harkavy-Friedman says, adding that “somebody at risk might not be thinking about it, and that’s one of the things that’s important about a measure that goes beyond ideation and behavior.”

A person may be at risk of suicide because they have a family history, history of depression, use substances, and have a head injury, Dr. Harkavy-Friedman gives as an example, and these factors combined may make the person less able to access their ways of coping. This person may not be thinking about suicide, but “in the face of extreme stress, it might come up, and they might act quickly” she says. “That’s the issue with suicide: for many, the time between thought and action is quick.”

Dr. Harkavy-Friedman makes the point that suicide risk is complex. “Risk is accumulated; it’s not like you’re either at risk or not at risk,” she says. “The more risk factors you have – again, in the context of stress – then that risk increases, and that’s what we’re trying to figure out.”

On the topic of the stresses of the pandemic, she advises clinicians to let their patients know that increased stress, anxiety, and depression is a normal, natural response.

Regarding suicidal behavior, she says that it is important for clinicians to know that just because someone is thinking about suicide, it does not mean that they are at risk for taking their lives. She recommends having open, ongoing conversations to find out:

  • If a patient is thinking about suicide, what are their thoughts?
  • Do they have a history of suicidal thoughts and behavior?

Interventions that help people manage their suicidal thoughts so they do not act on them are the most effective, she says. Reassuring your patients that they can discuss their suicidal thoughts with you and that you are not going to “rush to call the police or the emergency department” is important, she notes.

“Once you understand and you assess their risk, then you can make a decision about what the next steps would be,” she says.

Documentation is another important step, Dr. Harkavy-Friedman adds. It is important to document that you have asked about and assessed a patient’s suicidal ideation and behavior, that you have a plan with the patient, and what the details of that plan include. “We’re not responsible for guaranteeing that people don’t take their lives – we’re responsible for doing what we can, given what we know,” she says.

Listening and connecting with patients as well as keeping up with the latest research and best practices concerning suicide risk is what Dr. Harkavy-Friedman advises.

“I think that clinicians need to know that we have tools and interventions and ways to talk about and assess suicidal ideation and behavior now that we didn’t have in the recent past,” she says. “It’s important to get trained up and just listen to the people you’re working with; collaborate with them to develop plans for having a better life so they’re not thinking about taking their life.”


If you are in crisis, please call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255), or contact the Crisis Text Line by texting TALK to 741741.

Last Updated: Apr 22, 2021