New Validated, Personalized Screening Tool for Suicide Risk in Teens

What’s happening – Researchers have developed an adaptive, computerized screening tool to identify adolescents who are at risk for suicide. In a recent study, the screening was given to teens during ER visits across the US, regardless of the reason for the visit. The screening tool, called the Computerized Adaptive Screen for Suicidal Youth, or CASSY, was developed with a group of 2,075 adolescents aged 12 to 17 years and was validated in a second cohort of 2,754 adolescents of the same age range. In the second group, 165 youths made at least one suicide attempt within the 3-month study period. CASSY was able to predict suicide attempts with 88% accuracy.

The team of 20-plus researchers from universities and teaching hospitals across the US claim that CASSY provides more accurate – and personalized – predictions of suicide attempt risk in teens compared to other available screening tools, such as the ASQ, Columbia Suicide Screen, Risk of Suicide Questionnaire, Suicidal Ideation Questionnaire, and Diagnostic Predictive Scale. Some screens ask only Yes/No questions and/or may lead to a false positive. In addition to suicidal ideation, CASSY assesses for other risk factors such as sleep disturbance, trouble concentrating, depression, and agitation.

The details – Read the full study by King et al in JAMA Psychiatry.

The perspectives

Why it’s complicated – The strains of the almost year-long pandemic and resulting social isolation are causing worry about the mental health and suicide risk of young people.

  • NPR reported on warnings from child psychologists about teen suicide risk and highlighted the Las Vegas school district that chose to reopen due to the high number of suicides of its students since switching to virtual learning in March 2020.
  • The New York Times has featured two reports on pandemic-related suicide concerns, one focused on adolescents and one on young adults.
  • A study in Pediatrics by Hill et al compared pediatric emergency room suicide screening data from January through July for 2019 and 2020. The authors found higher reported rates of suicidal ideation and attempts in some months of 2020 compared to 2019, but not consistently higher rates in all the months studied.

The conversation

  • @DepressionCntr (The University of Michigan’s Depression Center) tweeted “‘About half of youth who die by suicide have never received any mental health services.’ -Dr. Cheryl King. Get to know CASSY, the digital screening tool to combat youth suicide developed at @umichmedicine.”
  • @advancingkids (Connecticut Children’s Community Health) tweeted a link to their organization’s universal screening program for suicide risk for ER visits.
  • @OHPediatricians (the Ohio chapter of the American Academy of Pediatrics) tweeted “Did you know almost half of Ohio homes have firearms? Healthcare professionals can help prevent teen suicide by screening for depression & having an open & productive dialogue on safe storage practices with patients. Visit for FREE resources.”

In practice – See our Psy-Q with Jill Harkavy-Friedman, PhD, of the American Foundation for Suicide Prevention (AFSP) for more detail on suicide risk and assessment. In a related news roundup, Psycom Pro looks at the links between suicide risk and borderline personality disorder and how The Trevor Project is helping to prevent suicide among LGBTQ individuals.

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.

Psy-Q: This Week's Challenge

How can screening techniques be improved to help prevent teen suicides? AFSP's Jill Harkavy-Friedman, PhD, answers.

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Epilepsy Patients Prefer Neurologists over Psychiatrists to Manage Depression and Anxiety

What’s happening – Neurologists are preferred over psychiatrists in patients with epilepsy and comorbid depression and/or anxiety. Researchers surveyed adults (64% women with a mean age of 42.2 years) at an epilepsy clinic who showed symptoms of depression and/or anxiety. When asked to choose between neurology prescribing and psychiatry referral, nearly 5:1 (83%) patients chose the former.

The details – Read the full study by Clary et al in Epilepsy & Behavior.

Why it’s complicated –  Clary et al wrote that anxiety and depression symptoms with epilepsy are “common, impactful and underrecognized and undertreated.” Poor access to mental health care, mental health stigma, or a desire for a simplified method of care may have been reasons why patients preferred neurology prescribing. No matter the reason, better ways of detecting and managing symptoms are needed in epileptic patients with psychiatric disorders.

The perspectives

  • An accompanying editorial in Epilepsy & Behavior examines the historical difference in approaches of neurology and psychiatry and asks whether neurologists agree with patients that they should handle treatment for psychiatric comorbidities.
  • A study from March 2020 by Clary and several of the same authors investigated the willingness of patients at an epilepsy clinic who screened positive for depression and anxiety to participate in further research.
  • A Cleveland Clinic study found that 1 in 10 children and youth with epilepsy (CYE) without a previous psychiatric diagnosis expressed suicidality when surveyed. The study screened for depression, anxiety, and suicidality and found higher rates compared to previous research. The authors recommended universal psychiatric screening of CYE.

The conversation

  • @CleClinicKids (Cleveland Clinic Children’s) tweeted “A Cleveland Clinic study of pediatric patients with #epilepsy and no mental health history found unprecedentedly high rates of #depression, #anxiety and suicidal thoughts.”
  • @EPICLongIsland, a mental healthcare provider, tweeted a link to an Epilepsy Foundation program that is offering training to mental health professionals: “Depression is a common psychiatric disorder among people with epilepsy. Project UPLIFT (Using Practice and Learning to Increase Favorable Thoughts) is a phone program that helps them challenge & let go of thoughts that affect mood, stress, & anxiety levels.”
  • @Congenica, a genomic medicine software company, tweeted “In this article, Amanda explains how picking up a paintbrush has helped her overcome the anxiety and depression that go hand in hand with her #epilepsy.”

In practice – Predictors and prevention of mental health disorders in children.

Opioid Prescribing Patterns in Patients with Mental Disorders

What’s happening – In a study of outpatient prescribing patterns, researchers found that physicians are more likely to prescribe opioids for adults with mood, anxiety, and non-opioid substance abuse disorders than to adults without these diagnoses. Using data from 166,927 outpatient visits for pain-related symptoms over a period of 15 years, the team found that opioids were prescribed in 16.8% of visits. A diagnosis of mood, anxiety, and non-opioid substance use disorders (SUDs) was associated with a higher likelihood of starting or refilling a prescription for opioids. PTSD and attention disorders (ADHD) were not associated with opioid prescriptions. People with psychotic disorders were unlikely to receive opioid prescriptions.

The authors note that the higher likelihood of opioid prescribing for adults with mood, anxiety, and non-opioid SUDs supports previous findings in large US studies. Prior research on opioid prescribing for patients with psychotic disorders has shown inconsistent results, and the authors note the need for more research on the complex issue of treating chronic pain in this population.

The details – Read the full study by Taylor et al in Drug and Alcohol Dependence.

Why it’s complicated – The complexities surrounding opioid prescribing are highlighted in a recent study by Lee et al in JAMA Network Open in which state policies from 2007-2018 designed to curb the opioid epidemic were examined. The authors found that policies aimed at reducing prescription opioid drug misuse may have the unintended consequences of people with opioid use disorder (OUD) seeking illicit substances, which can lead to higher mortality from illicit drug overdoses.

The perspectives –

  • Prescription opioid use may increase the risk for MDD and anxiety and stress-related disorders according to genetic evidence found in a study in JAMA Psychiatry.
  • The CDC recently released a report on trends in drug and synthetic opioid overdose deaths from 2013–2019, noting that the rate of deaths involving synthetic opioids other than methadone increased by 1,040%, and for psychostimulants, deaths increased by 317%.

The conversation

  • @AmerAcadPainMed (American Academy of Pain Medicine) tweeted and linked to an article from the AP stating “AAPM President-Elect Mike Hooten quoted in AP article ‘Doctors who say no to opioid use face threats from patients’”
  • @ABC tweeted “According to latest research, the opioid epidemic did not disappear. Rather, it lurked in the shadows of the coronavirus pandemic, growing in strength and taking advantage of a society now more susceptible than ever,” and linked to this report.
  • @jennbrasch (Dr. Jenn Brasch, president of the Canadian Society of Addiction Medicine) tweeted “What to consider when a psychiatric patient is prescribed opioids: using psychological Rx for pain; treating depression, anxiety, PTSD; insomnia; concurrent alcohol use; development of #Opioid use disorder; all important!” and linked to this JAMA Psychiatry article.

In practice – How to safely prescribe benzodiazepines and opioids and how to prescribe buprenorphine for OUD as part of medication-assisted treatment. More on opioid prescribing for chronic pain conditions in our sister publication PPM.

Last Updated: May 7, 2021