One of many essential considerations about asking preadolescents (8-12 yr olds) about suicidal ideas is the worry that it’ll really trigger or improve suicidal ideas (i.e, have an iatrogenic impact). As a result of preadolescence is a time of fast cognitive growth, the place younger folks could also be extra suggestible, it has been proposed that asking or speaking to them about delicate subjects like suicide may trigger misery and introduce concepts that that they had not beforehand thought of (Ayer et al., 2020). This makes folks hesitant to ask preadolescents about suicidal ideas, each in analysis and in apply.
Nonetheless, one overview discovered that round one in 13 kids youthful than 12 years outdated expertise suicidal ideation (learn extra in a current weblog by Rasanat and Mahmoud).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 scientific dilemma: avoiding the subject might really feel protecting however by failing to ask, you danger not providing help to kids who’re already battling suicidal ideas.
Encouragingly, there’s proof to recommend early identification of suicidal ideas and acceptable intervention could be efficient in lowering 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 chance of inflicting misery, however not asking might imply lacking the chance to offer help.
Strategies
The examine adopted preadolescents from Missouri who had beforehand taken half in analysis evaluating psychotherapy for preschool-onset main depressive dysfunction (PO-MDD). At baseline, individuals 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 following 12 months, individuals accomplished an tailored on-line model of the Ask Suicide-Screening Questions (ASQ; Horowitz et al., 2012). Decrease-risk individuals accomplished it month-to-month, whereas higher-risk individuals accomplished it weekly. The tailored software included three gadgets concerning the previous week (wishing to be useless, feeling others can be higher off in the event that they have been useless, and ideas of killing themselves), with the authors including a fourth merchandise to evaluate present intent. Any “sure” response was counted as a constructive 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 individuals to take away preadolescents with any historical past of PO-MDD, as PO-MDD strongly predicts suicidal ideas in adolescents.
Outcomes
Total, 192 preadolescents agreed to participate and accomplished at the least one ASQ survey. The imply age of individuals was 10.13 years outdated (SD = 1.02) and 79.2% of the individuals have been White. Within the lower-risk group (n = 68), 98.4% of the screens throughout the 12 months have been detrimental and just one.6% have been constructive. For the higher-risk group (n = 124) throughout the 12 months, 93% of screens have been detrimental and seven% have been constructive.
Decrease-risk group
Analyses discovered:
- No relationship between what number of ASQ surveys have been accomplished and what number of have been constructive screens (r = 0.16, p = .192) which means that there was no cumulative impact of finishing the screening on rising suicidal ideas.
- No proof that the survey week (i.e., what number of instances a preadolescent was requested about suicidal ideas) predicted the probabilities of a constructive display screen (i.e., extra studies of suicidal ideas) (OR = 1.04, 95% CI [1.00 to 1.09], p = .067) even when controlling for intercourse at delivery and within-subject age.
- No proof that finishing the survey in a single month predicted the chance of a constructive display screen within the subsequent month (OR = 0.40, 95% CI [0.07 to 2.19], p = .288), together with when intercourse at delivery and within-subject age was managed for.
A Bayes issue evaluation supported the null findings, and outcomes from the sensitivity evaluation have been just like the first evaluation, reinforcing that there isn’t a proof that repeat ASQ screening will increase constructive 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 obtained the ASQ weekly:
- No vital affiliation between survey completion charges and constructive screenings (r = 0.11, p = .242).
- Survey week didn’t predict constructive screens (OR = 0.99, 95% CI [0.98 to 1.00], p = .160)
- No relationship between finishing the survey one week and the probabilities of a constructive 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
Total, this examine discovered preliminary proof to recommend that repeated suicide screening will not 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 constructive display screen, nor that finishing a screening one week/month elevated the chance of a constructive display screen the following week/month. The authors concluded that, whereas there are justifiable considerations about asking preadolescents about suicidal ideas:
Findings recommend that funders, investigators, dad and mom, and youth can really feel extra assured about youth taking part 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 examine recommend that it’s comparatively secure to ask preadolescents about suicidal ideas within the context of psychological well being analysis, which can switch to scientific settings.
Strengths and limitations
Strengths
- The mixture of various statistical checks used by the authors (i.e., hierarchical fashions, Bayes components) strengthens the interpretation of the examine findings, rising our confidence that there isn’t a influence 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 primarily based on knowledge from the ASQ, which is a validated software with robust psychometric properties. This will increase our confidence that the examine really measured suicidal ideas, and that this was completed in a constant and dependable approach.
- The completion charges for the ASQ screenings have been excessive (~75-75%) which means that the information is more likely 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 numerous teams. That is significantly vital, as proof suggests there’s a increased suicide danger and charge amongst minority ethnic youth in contrast with White youth (Alvarez et al., 2022), which can be related to suicide-risk screening.
- Equally, among the cohort used on this examine had beforehand undergone psychotherapy for PO-MDD. Whereas sensitivity analyses addressed the confounding issue of PO-MDD historical past, it’s unclear what influence the intervention and former publicity to the subject of suicidal ideas might have had.
- Relatedly, many doubtlessly confounding components weren’t included within the evaluation which can have had an influence, such a life occasions (e.g., lack of a liked one, dad or mum divorce).
- Whereas the present intent merchandise that was added to the ASQ was vital for the examine’s objective, 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 energy of the examine, it’s unclear what influence the authors’ variations had on its psychometric properties and general reliability.
Implications for apply
Findings from this examine appear to help that for this pattern, repeatedly asking about suicidal ideas throughout 12 months doesn’t improve suicidal ideas incidence. Though these findings are preliminary, with the authors emphasising that they “wish to watch out about claiming no danger for youth when participating in suicide-risk screening”, it may 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, nevertheless it additionally might assist clinicians to really feel extra assured in proactively asking about suicidal ideas. This might end in earlier identification of suicidal ideas and extra wrap-around take care of these in want, which may very well be essential in lowering suicide danger for this inhabitants. Mother and father and carers may also be reassured that there’s restricted danger in preadolescents participating in this kind of analysis or doubtlessly being requested these questions by clinicians.
Nonetheless, some warning continues to be wanted because of the lack of readability whether or not these findings can be relevant throughout totally different populations and settings. Future analysis ought to embody preadolescents from totally different racial and ethnic backgrounds, as effectively at those that have by no means obtained any psychological well being help. Moreover, the ASQ asks about suicidal ideas over the previous week; future analysis may think about using strategies akin 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 may very well be distinction.
There’s additionally a wider dialog available round how clinicians ought to display screen for suicidal ideas. Younger folks have expressed detrimental 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 end in inappropriate or missed referrals and influence their rapport with sufferers because of the questions on assessments typically being blunt and insensitively phrased (Michail et al., 2015). Additional qualitative analysis may very well be used to discover preadolescents’ perceptions and views of being repeatedly administered the ASQ screener, which may present additional perception into the present examine’s findings.
Future research may prolong this analysis to see if extra frequent screening, akin to each day diaries or ecological momentary evaluation, is equally secure on this inhabitants.
Assertion of pursuits
Kayley McPherson has no battle of curiosity to reveal.
Edited by
Dr Nina Higson-Sweeney.
Hyperlinks
Major paper
Laura Hennefield, Katherine R. Luking, Rebecca Tillman, Deanna M. Barch, Joan L. Luby, & Renee J. Thompson (2026). Asking preadolescents about suicide will not 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, Okay., Polanco-Roman, L., Samuel Breslow, A., & Molock, S. (2022). Structural racism and suicide prevention for ethnoracially minoritized youth: a conceptual framework and illustration throughout techniques. 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, Okay., Byrne, S. J., Boland, A., Michail, M., … & Robinson, J. (2020). Finest apply when working with suicidal behaviour and self-harm in major 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 short instrument for the pediatric emergency division. Archives of Pediatrics & Adolescent Medication, 166(12), 1170-1176. https://doi.org/10.1001/archpediatrics.2012.1276
Michail, M., & Tait, L. (2016). Exploring common practitioners’ views and experiences on suicide danger evaluation and administration of younger folks in major care: A qualitative examine 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.
