The following is a summary of “Adolescent Suicide Risk Screening: A Secondary Analysis of the SHIELD Randomized Clinical Trial,” published in the December 2022 issue of Pediatrics by Sekhar, et al.

SHIELD (Screening in High Schools to Identify, Evaluate and Lower Depression) randomized clinical trial data were used in a secondary analysis to assess the efficacy of adolescent suicide risk screening to increase the initiation of mental health services (MDD).

With any response >0 to item 9 regarding suicide risk being considered positive, students in 14 Pennsylvania high schools were randomized by grade to either the standard school practice of targeted referral for behavior raising concern for suicide risk or universal screening using the Patient Health Questionnaire-9 (PHQ-9). Referrals to the Student Assistance Program (SAP), which was required in all Pennsylvania schools, were made for any students identified in either arm. The SAP chose to follow up. Researchers compared the study groups using mixed-effects logistic regression.

About 12,909 kids made up the participant population, and 6,473 (50.1%) were randomly assigned to universal screening. Around 46% of the research group’s participants were female, and 43% were Black or non-Hispanic. Adolescents in the universal screening group had chances of being recognized as being at suicide risk that were 7.1 times higher (95% CI, 5.7-8.8), follow-up requirements that were 7.8 times higher (95% CI, 4.6-13.1), and starting mental health treatment that was 4.0 times higher (95% CI, 2.0-7.9).

Despite being a screening tool for MDD, the PHQ-9’s use in universal screening boosted the identification and beginning of treatment for teenagers at risk for suicide. It supported the need for universal screening and implied that a risk assessment focused specifically on suicide might have an even higher impact on the start of treatment for identified youngsters.