Retrospective Evaluation of the Implementation of Universal Suicide Risk Screening for Youth in the Perioperative and Procedural Areas of a Health System.

BACKGROUND

Suicide is a leading cause of death among US youth. Universal suicide risk screening can identify youth with unmet mental health needs, enabling interventions and linkage to services, yet screening is not widely implemented in perioperative and procedural settings.

AIMS: We retrospectively assessed implementation of universal suicide risk screening for youth in perioperative and procedural areas of a pediatric health system by examining screening completion rates, positivity rates, and demographic and clinical factors associated with screening.

METHODS

We conducted a retrospective cross-sectional study of universal suicide risk screening among youth 10-21 years of age in perioperative and procedural areas of an academic children's hospital and two affiliated ambulatory surgical centers, using electronic health record data from August 2022 to February 2025. We described rates of screening completion using Ask Suicide-Screening Questions (ASQ) and screening positivity rates. We used multivariable logistic regression to examine factors associated with (1) screening completion and (2) positive screens.

RESULTS

Among 15 204 perioperative and procedural encounters (median age 14 [interquartile range 12, 16], 45% female), 13 566 (89.2%) had at least one ASQ item completed. Of these encounters, 494 (3.6%) had positive screens and 7 (0.1%) had screens indicating imminent risk. Adjusted odds of screening completion were lower among youth aged 10-12 than 13-15 years (adjusted odds ratio [aOR] 0.69, 95% CI 0.61-0.78) and those who preferred a language other than English or Spanish versus those who preferred English (aOR 0.55, 95% CI 0.41-0.75). Adjusted odds of positive screens were higher among females than males (aOR 2.49, 95% CI 2.06-3.03) and lower in ambulatory surgical centers than the children's hospital (aOR 0.26, 95% CI 0.14-0.42).

CONCLUSIONS

Universal suicide risk screening can be implemented in perioperative and procedural areas, with positive screens in about 1 in 28 encounters. These settings represent an underutilized opportunity to identify at-risk youth.