Level of behavioral health integration and suicide risk screening results in pediatric ambulatory subspecialty care

Objective
This study aimed to characterize suicide risk screening results for youth in pediatric ambulatory subspecialty clinics.
Method
The Ask Suicide-Screening Questions was administered to patients ages 9–24 years in 12 subspecialty clinics to assess suicide risk, determined by suicide ideation/behavior. The SAMSHA-HRSA standard framework for integrated health was used to categorize each clinic’s level of behavioral health integration.
Results
6365 patients completed 7440 suicide risk screens; 6.2% of patients screened positive at their initial screen and 4.1% at subsequent annual screens. There was no dose-response pattern between increasing level of integration and decreasing likelihood of a positive suicide screen. Youth identifying as gender expansive were 3.1 times (95% CI [2.0, 4.9]) more likely to screen positive as compared to cisgender youth, adjusted for age, gender, race/ethnicity, screen type, year, and clinic integration level.
Conclusion
Results surrounding disparities in suicide risk based on gender identity underscore the importance of further investigating how to optimally identify and manage high-risk, often understudied youth at suicide risk.