Suicide is the fourth leading cause of death in children between the ages 10 -14years (DeMaso, 2011). Horowitz, Ballard & Pao (2010) noted that every year, suicide claims the lives of tens of thousands of young children worldwide. Despite its high prevalence and known risk factors, suicidality is often undetected by health care professionals (Horowitz, Ballard and Pao, 2010).
Most primary care clinicians (PCCs) and emergency department (ED) clinicians do not routinely screen for suicide risk in children. Studies have revealed that as many as 83% of suicide attempters are not identified as a danger to themselves by healthcare providers, even when examined by PCCs in the months before their attempt(Horowitz,Ballard &Pao,2010).
Undetected and untreated mental health problems in children and adolescents can lead to problems in school, the family and peer and intimate relationships, adult psychopathology and a poor quality of life for the child (Horowitz, Ballard & Pao,2010).Therefore, it is important that children be screened so that early detection of those at risk can be identified.
The most popular screening tool that is used in school settings and primary care settings, is the Columbia Suicide Screen (CSS). The CSS was developed to detect children and adolescents who are at risk for suicide, so that brief interventions can be implemented and a life can be prolonged or saved. The CSS is an 11-item self-report measure embedded in a general health questionnaire that investigates lifetime suicide attempts, suicidal ideation, negative mood and substance abuse issues (Horowitz, Ballard & Pao, 2010). It is an easy to score and an easy to administer screening tool.
Children and parents can self-administer the tool and report the results to their PCCs. Research using the CSS suggested that screening can identify suicide risk in children whose thoughts and behaviors may have gone otherwise undetected (Horowitz, Ballard & Pao, 2010).
The CSS is a widely used tool that was validated using the National Institute of Mental Health Diagnostic Interview Schedule for Children, IV (NIMH DISC-IV) with a sensitivity of 0.75, a specificity of 0.83(Horowitz,Ballard & Pao,2010). It was proven to be a valid and reliable screening tool after several test-retest trials in a variety of school research studies (Shaffer et al. 2004). This further demonstrates the utility and validity of the screening tool for use in primary care settings.
The CSS tool can be used in primary care settings by Behavioral health consultants (BHC) for children and adolescents who may present with symptoms related to depression, anger or bullying (Horowitz, Ballard & Pao, 2010). The CSS can also be used as a routine measure for children who visit the ED or the primary care clinics. The CSS can be self-administered and it is quick to score, which makes it an appropriate tool for use in a fast paced primary care setting or ED.
A positive screen or score on the CSS, would indicate that a child is at risk for suicide and immediate interventions can then be implemented for the child and the family. Any indication of a child at risk can be quickly addressed and managed before the child experiences further psychopathology or death.
Suicide among children has become an epidemic. It is important that health care professionals engage in screening so that early detection of children at risk for suicide can be identified and brief interventions can be implemented.
DeMaso,D.R.(2011). Suicide and Teens. Retrieved from http://www.childrenshospital.org
Horowitz,L., Ballard,Elizabeth.,& Pao,M. (2010). Suicide Screening in Schools, Primary care and emergency departments. National Institute of Health Public Access. doi:10.1097/MOP.0b013e3283307089
Shaffer, D., Scott,M.,Wilcox, H., Maslow. C.,Hicks,R.,Lucas, C.P.,Garfinkel, R., & Greenwald. S. (2004). Columbia Suicide Screen: Validity and reliability of a screen for youth suicide and depression. Journal of the American Academy of Child and Adolescent Psychiatry. [Abstract]. Retrieved from http://www.ncb.nlm.nih.gov
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