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- Title
Evaluating Iatrogenic Risk of Youth Suicide Screening Programs: A Randomized Controlled Trial.
- Authors
Gould, Madelyn S.; Marrocco, Frank A.; Kleinman, Marjorie; Thomas, John Graham; Mostkoff, Katherine; Cote, Jean; Davies, Mark
- Abstract
Context: Universal screening for mental health problems and suicide risk is at the forefront of the national agenda for youth suicide prevention, yet no study has directly addressed the potential harm of suicide screening. Objective: To examine whether asking about suicidal ideation or behavior during a screening program creates distress or increases suicidal ideation among high school students generally or among high-risk students reporting depressive symptoms, substance use problems, or suicide attempts. Design, Setting, and Participants: A randomized controlled study conducted within the context of a 2-day screening strategy. Participants were 2342 students in 6 high schools in New York State in 2002-2004. Classes were randomized to an experimental group (n = 1172), which received the first survey with suicide questions, or to a control group (n = 1170), which did not receive suicide questions. Main Outcome Measures: Distress measured at the end of the first survey and at the beginning of the second survey 2 days after the first measured on the Profile of Mood States adolescent version (POMS-A) instrument. Suicidal ideation assessed in the second survey. Results: Experimental and control groups did not differ on distress levels immediately after the first survey (mean [SD] POMS-A score, 5.5 [9.7] in the experimental group and 5.1 [10.0] in the control group; P = .66) or 2 days later (mean [SD] POMS-A score, 4.3 [9.0] in the experimental group and 3.9 [9.4] in the control group; P = .41), nor did rates of depressive feelings differ (13.3% and 11.0%, respectively; P = .19). Students exposed to suicide questions were no more likely to report suicidal ideation after the survey than unexposed students (4.7% and 3.9%, respectively; P = .49). High-risk students (defined as those with depression symptoms, substance use problems, or any previous suicide attempt) in the experimental group were neither more suicidal nor distressed than high-risk youth in the control group; on the contrary, depressed students and previous suicide attempters in the experimental group appeared less distressed (P = .01) and suicidal (P = .02), respectively, than high-risk control students. Conclusions: No evidence of iatrogenic effects of suicide screening emerged. Screening in high schools is a safe component of youth suicide prevention efforts.
- Subjects
SUICIDE risk factors; MEDICAL screening evaluation; SUICIDAL behavior; SUICIDE prevention; SELF-destructive behavior in adolescence; ADOLESCENT health; HEALTH risk assessment; HEALTH of high school students
- Publication
JAMA: Journal of the American Medical Association, 2005, Vol 293, Issue 13, p1635
- ISSN
0098-7484
- Publication type
Article
- DOI
10.1001/jama.293.13.1635