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Why Your Child May Be Asked about Suicide at Your Next Doctor’s Appointment

Experts stress the importance of screening young people for suicidal thoughts and depression

Along with routine questions about your child’s diet, growth and development, more and more pediatricians are asking children difficult questions about depression and thoughts about suicide.

Kristen Pyrc, M.D., co-medical director of Psychiatry at Cook Children’s, realizes suicide in children and adolescents is a difficult topic for most parents. But she stresses it’s one that can’t be ignored.

“As a mental health professional, my worst fear is a child prematurely ending his or her own life,” Dr. Pyrc said. “As a mother, it is hard to comprehend the profound grief families must feel in the wake of a suicide.”

A study published by the American Academy of Pediatrics found that kids ages 5 to 17 were admitted to children’s hospitals for thinking about or trying to kill themselves twice as often in 2015 as 2008. Researchers at Monroe Carell Jr. Children’s Hospital at Vanderbilt embarked on the study after noticing more pediatric patients being kept in the hospital with mental health issues.

Statistics show suicides among young people can happen at almost any age. Suicide is the second leading cause of death for children, adolescents and young adults, ages 5 to 24 years old.

Because of these numbers, the American Academy of Pediatrics has updated their guidelines to recommend pediatricians routinely check for signs of depression in their young patients. The focus is to carefully screen patients ages 12 and over during annual checkups.

Brad Mercer, M.D., a pediatrician at Forest Park, calls the recent focus on mental health “a wake-up call” to American pediatricians and family practitioners who treat kids, especially adolescents. He said more health care providers must make time to ask children about depression and suicidal thoughts.

“We must address the mental health problems in our youth as a preventive measure,” Dr. Mercer said. ““As pediatricians, we have to take the time to interact with teens and take the time to screen for these conditions during regular office visits,”

Cook Children’s has taken several steps to screen patients throughout its system:

  • Cook Children’s offers the American Psychiatric Nurse’s Association Competency Based training (6.5 hours) on suicide assessment, intervention and prevention. As of mid-September, 110 nurses and therapists have been trained in this evidence-based curriculum.
  • Patients are screened at the initial intake assessment and throughout the stay on inpatient psychiatry and Partial Hospitalization Program (PHP).
  • The Emergency Department (ED) and the Department of Psychiatry have combined their efforts to begin screening all patients who present to the ED ages 10 years and older, regardless of the child’s presenting problem. The staff also uses an evidence-based screening tool called the “Ask Suicide Screening Questionnaire-ASQ.
  • Cook Children’s also screens for mental health issues and/or suicide in outpatient clinics (primary care and specialty), as well as screening for suicidal thoughts at each Psychology outpatient visit.

“This process has already identified several children with mental health issues and at risk of suicide that may not have previously been identified. We know that screening for suicide risk, referring to the appropriate level of care, providing a safe environment with skilled staff observation for high risk patients, and offering suicide education is imperative to address suicide prevention,” said Lisa Farmer, director of Psychiatry at Cook Children's.

Vanessa Charette, M.D., said she and her fellow pediatricians at Magnolia, screen every patient at well-child checkups, ages 12 and up for depression.

“I have found it is a good way to signal to kids and parents that we are open to talk about this and want them to ask us about it,” Dr. Charette said. “Even if on the well check nothing comes up, often a parent will return with the teen later wanting to talk about anxiety and depression. I believe the screen helps open that door and the conversation. I also find for teens that are not having any signs of depression/anxiety and wonder why they are doing the screen it still opens a conversation. I then talk about how it is great that they are doing well but that many kids are not. Parents appreciate this – it helps open why some other kids might be depressed, what can be done to prevent it and helps with empathy for others.”

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