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Evaluating Iatrogenic Risk of Youth Suicide Screening Programs
A Randomized Controlled Trial
Madelyn S. Gould, PhD, MPH;
Frank A. Marrocco, PhD;
Marjorie Kleinman, MS;
John Graham Thomas, BS;
Katherine Mostkoff, CSW;
Jean Cote, CSW;
Mark Davies, MPH
JAMA. 2005;293:1635-1643.
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.
Author Affiliations: Division of Child and Adolescent Psychiatry (Dr Gould, Mss Mostkoff and Cote, and Mr Thomas) and Department of Epidemiology (Dr Gould), Columbia University and New York State Psychiatric Institute (Drs Gould and Marrocco, Ms Kleinman, and Mr Davies), New York, NY.
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