Suicide Risk Among Youth Who Choose “No Response” on Emergency Department Suicide Risk Screenings

INTRODUCTION: We compare suicidal behavior outcomes for adolescents who select "no response" on Ask Suicide-Screening Questions (ASQ) items in the emergency department (ED) with those of adolescents who screen negative or positive. METHODS: The multisite Emergency Department Screen for Teens at Risk for Suicide (ED-STARS) study prospectively enrolled adolescents at ED visits, randomizing a subset to follow-up of six-month duration. Participants and parents/guardians completed mental health surveys during the ED encounter and (if applicable) at 3- and 6-month. Risk group was assigned based on ED ASQ score (positive, negative, or nonresponse). Primary outcomes were suicidal ideation, suicide attempt, and mental health service use within 6 months. RESULTS: There were 6411 participants assigned to an ASQ group; 2296 participated in follow-up. Nonresponse was associated with intermediate risk for suicidal ideation (nonresponse group adjusted odds ratio [OR] 2.14 [95% CI 1.33-3.41]; positive group 4.35 [2.93-6.51]), attempt (nonresponse group adjusted OR 2.82 [0.97-8.41]; positive group 5.35 [2.25-14.33]), and mental health care receipt (nonresponse group unadjusted OR 3.42 [1.56-7.59]; positive group 9.88 [5.60-17.79]). CONCLUSIONS: Youth choosing nonresponse on suicide screening questions may be at elevated risk for suicidal ideation and behavior; ED clinicians should not default to treating these youth as negative screens.