P2.D076: Youth Perceptions of Electronic Suicide Risk Screening in the Pediatric Emergency Department

Background: Emergency Department (ED) suicide screening practices are institution-specific and vary by screening tool, delivery method, and follow-up protocols. Electronic-based screening (previously used for sexual health, postpartum depression, and intimate partner violence detection in adolescents) may improve perceived anonymity, privacy, and overcome social vulnerability bias. This study evaluated youth perceptions of electronic screening for suicide risk in the pediatric ED.

Methods: We conducted a cross-sectional study with a convenience sample of youth (aged 10-17 years) who completed routine electronic suicide risk screening using the Ask Suicide Screening Questions (ASQ) in the pediatric ED between October 2023 and March 2024. After screening, participants were asked to complete a feedback questionnaire. Legal sex, age, race, ethnicity, and insurance status were abstracted from the electronic health record. ASQ results, time to completion in minutes, and feedback responses were collected. The project was approved by the Colorado Multiple Institutional Review Board at the University of Colorado with waiver of informed consent. Descriptive data were summarized using counts and percentages for categorical variables and medians and interquartile ranges for continuous variables. Pearson’s chi-squared tests and Fisher’s exact tests were used to test associations between feedback response and legal sex, age, race, ethnicity, and insurance.

Results: Overall, 368 patients completed routine electronic suicide screening with the ASQ; 54% (n=197) were female, 60% (n=219) were white, 49% (n=181) were Hispanic, 63% (n=233) were publicly insured, and the median age was 14.00 years (IQR 12.00, 16.00). Most patients (88%) had a negative suicide risk screen. ASQ screening completion required 1.37 minutes (IQR 0.95, 2.15). Few respondents (10%, n=34) felt that youth should not be screened for suicide in the ED, however, 21% (n=69) described the experience as ‘not at all positive.’ Most participants (74%, n=246) reported a preference for electronic suicide screening as compared to paper or verbal screening. Respondents found the electronic screen ‘very easy’ (50%) or ‘easy’ (33%) to use, answered ‘yes, completely’ (73%) or ‘yes, mostly’ (17%) to the tool promoting honest responses, and reported privacy/confidentiality with electronic screening (68%). A higher proportion of younger patients (aged 10-14) had privacy/confidentiality concerns (p=0.006). Hispanic patients had a less positive experience (p=0.005) and reported greater difficulty answering suicide risk questions on an electronic device (p=0.018).

Conclusion: Within the study cohort, electronic suicide screening in the ED was preferred, easy to use, promoted honesty, and maintained patient privacy/confidentiality. Using patient-facing electronic screening, we demonstrate a feasible, acceptable, and efficient process for standardizing suicide risk screening in the pediatric ED. Additional work is needed to further explore how age, ethnicity, and other attributes (such as language spoken) contribute to perceptions of ED-based suicide screening in youth.