Study Underscores the Case for Universal, Suicide-Specific Screenings for Young People

Dr. Alexandra Huttle

During the early months of the COVID-19 pandemic, Dr. Alexandra Huttle, Assistant Professor of Clinical Pediatrics in the Department of Pediatrics and an Instructor in Medicine in the Weill Department of Medicine, saw a striking number of her young patients presenting suicidal ideation (SI), notably three cases of recent suicide attempts (SA) by children under the age of 12 in a single week. Dr. Huttle was halfway through her pediatrics residency at NewYork-Presbyterian/Weill Cornell Medical Center.

Broadly defined as having “thoughts, fantasies, or contemplations about ending one's own life,” suicidal ideation can range from fleeting thoughts to detailed planning. “The mental health (MH) crisis—especially among young people—was exacerbated by the pandemic, just like the pandemic exacerbated so many issues around healthcare and healthcare systems,” Dr. Huttle said. “It became clear to me that it was vital to have interventions start earlier, before children came to the Emergency Department (ED).” Her experiences propelled research highlighting the need to implement universal suicide-specific screenings for all young people starting at age 12. This recommendation is the core of a study published in Academic Pediatrics earlier this year titled Differences in Reporting Suicide Ideation and Attempt: Implications for Suicide Risk Screening in Pediatric Primary Care, which was first authored by Dr. Huttle. Contributors included Dr. Erika Abramson, a pediatric hospitalist at Weill Cornell Medicine, and fellow researchers from Albert Einstein College of Medicine; The Graduate Center, City University of New York (CUNY); Hunter College; NYC Health + Hospitals; and Yeshiva University.

The researchers analyzed interviews and self-report measures assessing for suicide-related risk, depression and anxiety from a group of 162 New York City-area adolescents with SI or SA. They found the adolescents underreported past-month SI in a depression screening versus a suicide-specific screen. Participants with less severe mental health-related symptoms were significantly less likely to report past-month SI consistently. The findings, Dr. Huttle argues, support the need for both universal, suicide-specific screenings starting at age 12, as well as more frequent screenings, to best capture youth at risk.

In 2023, suicide was the second leading cause of death among children ages 10-18, with evidence suggesting many adolescents who die by suicide visit an outpatient pediatric provider before their death.[1]  “Pediatricians are in a unique position to identify suicide-related risk as community-level shortages of mental helath professionals leave many children and adolescents with unmet mental health needs, particularly since the pandemic,” Dr. Huttle said.

While the American Academy of Pediatrics (AAP)/Bright Futures Recommendations for Preventive Pediatric Care has endorsed universal suicide risk screenings in all youth starting at age 12, the U.S. Preventive Services Task Force has cited insufficient evidence, though it does recommend universal adolescent depression screenings, which includes suicide risk-related questions.

Despite the advances in reducing stigma around mental health issues, there is still significant stigma around suicide, Dr. Huttle said, including how we talk about it. “It’s so important to have more conversations around suicide and suicide-related risk with our patients, perhaps by asking about suicide in different ways, and by asking different questions,” she said, crediting longtime mentor Dr. Cori Green for her ongoing collaboration and guidance. Dr. Huttle is clear that a multitiered approach to interventions, including collaborative safety planning with patients and their caregivers, and strengthening ties to family, friends and community, can be lifesaving.