Screening and Follow-Up Treatment Practices for Suicide Risk in Adolescent Primary Care: A Retrospective Chart Review

Universal depression screening in adolescent primary care often encompasses questions about suicide risk. We conducted a retrospective chart review of well-child visits where adolescents (ages 13-17.9) had endorsed self-injurious thoughts and behaviors or suicidal ideation. The goal was to investiga...

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Bibliographic Details
Published in:Clinical pediatrics 2025-01, Vol.64 (1), p.101-110
Main Authors: Butler, William, Lewis, Kristina L., Benheim, Talia S., Arauz Boudreau, Alexy, Brigham, Kathryn S., Feldman, Mitchell, Jellinek, Michael, Murphy, J. Michael
Format: Article
Language:English
Subjects:
Adolescent
Depression - diagnosis
Depression - psychology
Emergency medical care
Female
Humans
Male
Mass Screening - methods
Mental depression
Primary care
Primary Health Care
Referral and Consultation - statistics & numerical data
Retrospective Studies
Risk Assessment - methods
Self-Injurious Behavior - diagnosis
Self-Injurious Behavior - psychology
Self-Injurious Behavior - therapy
Self-injury
Suicidal behavior
Suicidal Ideation
Suicide
Suicide Prevention
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Summary:Universal depression screening in adolescent primary care often encompasses questions about suicide risk. We conducted a retrospective chart review of well-child visits where adolescents (ages 13-17.9) had endorsed self-injurious thoughts and behaviors or suicidal ideation. The goal was to investigate primary care providers’ follow-up actions, including documentation, further assessment, and referrals. Over 3-quarters of the progress notes showed evidence of further assessment, and two-thirds documented same-day actions, including mental health referrals, emergency department referrals, safety plans, medication changes, primary-care follow-up, and talking to parents. Actions varied by depression severity. Cases without interventions often had justifications. Owing to the variety of possible meanings and severity underlying positive screens, providers implemented an array of interventions, using clinical judgment to tailor actions to patients’ individual needs and preferences. From these observations, we propose that standardized guidelines for suicide risk screening and follow-up should involve a clinical assessment and individualized treatment planning.
ISSN:0009-9228
1938-2707
1938-2707
DOI:10.1177/00099228241253158