Chain of Care Approaches to Address Suicide Risk in Black Youth

• In Event: National Institute of Health Funding to Address Pediatric Health Disparities

Abstract

We have shown that routine systematic Ask Suicide-Screening Questions (ASQ) suicide risk screening doubles detection of pediatric emergency department patients at potential future risk for suicidal behaviors (Ballard et al, 2017; DeVylder et al., 2019). We found that 1229 of over 15,000 patients ‘uniquely identified’ (i.e, did not come to ED with chief complaint of suicidal ideation or attempt but screened positive), a higher proportion were black males (DeVylder et al., 2019). This points to the potential value of ASQ screening to help us mobilize to more proactively address suicide-related health disparities.
Our work shows that youth as young as 8 and 9 years old can be feasibly routinely screened for suicide risk (Cwik et al, under review). The profile of co-occurring symptoms for those 8 and 9 years-old who screened positive differs from the older patients (10+) who screened positive. The younger patients who screened positive were more likely to present with a chief complaint of externalizing symptoms and hallucinations, and less likely with ideation or an attempt, than their older counterparts. Comorbid post-traumatic stress disorder (PTSD) and ADHD were also more prevalent in the younger group, with comorbid depression significantly less prevalent (Cwik et al, under review). Analyses revealed that the younger group who screened positive were almost three times more likely to come back in 12 months for a suicide-related visit. This indicates that chain of care interventions for suicidal youth are urgently needed to prevent future suicide-related morbidity and mortality.
To encourage ongoing social connection and care engagement, we piloted a brief caring text messaging approach for suicidal patients after discharge from our urban pediatric Emergency Department. Results indicated that a text messaging intervention is both feasible and acceptable for pediatric ED patients identified as being at risk for suicide. We have preliminary evidence that a series of brief caring text messages over three months reduced future suicidal ideation and attempts (Ryan et al., under review).
Americans of color are bearing the brunt of three ongoing national crises: COVID-19 – the deadliest infectious disease threat in a century, high rates of unemployment, and racial and police violence. Those most negatively impacted by COVID-19 morbidity and mortality are predominately Black, Hispanic/Latinx, Native American, and immigrant communities and individuals. The COVID-19 pandemic intersects with rising mental health issues in childhood and adolescence, the most prominent of which are increased rates of depression, anxiety and suicide. The suicide rate in Black youth under 13 is two times higher than it is among white youth under 13 (Bridge et al., 2015, 2018). The suicide death rate among Black youth was found to be increasing faster than any other racial/ethnic group. We will focus on chain of care approaches to address suicide risk in Black youth.

Authors

• Holly C. Wilcox, Johns Hopkins University
  Presenting Author

• Mary Cwik, Johns Hopkins University
  Non-Presenting Author

• Mitchell Goldstein, Johns Hopkins University
  Non-Presenting Author

• Crystal Barksdale, National Institute of Mental Health
  Non-Presenting Author

• Beda Jean-Francois, NIH/NCCIH
  Non-Presenting Author