Adolescent patients - Healthy or hurting? Missed opportunities to screen for suicide risk in the primary care setting

Context: Adolescent suicide rates have increased dramatically in recent dec ades. Suicide is the third leading cause of mortality among persons aged 10 to 19 years. Several official guidelines recommend screening for suicidal behavior in the primary care setting. Objectives: To determine the prevalence of adolescent suicidal behavior kno wn to primary care providers and to determine the knowledge, attitudes, and practice of primary care physicians in Maryland regarding screening for ri sk factors for adolescent suicide. Design: Cross-sectional study using mailed survey. Setting: Maryland from May to July 1995. Participants: All pediatrician (n = 816) and family physician (n = 592) mem bers of the state chapter of the American Academy of Pediatrics and the Ame rican Academy of Family Physicians, respectively, who were actively providi ng ambulatory care. Main Outcome Measures: Adolescent suicidal behavior known to primary care p roviders and predictors of routine screening for risk factors for adolescen t suicide. Results: The response rate was 66%. Three hundred twenty-eight physicians ( 47%) reported that 1 or more adolescent patients attempted suicide in the p revious year, but only 158 (23%) either frequently or always screened adole scent patients for suicide risk factors. Significant factors correlating wi th routine screening for suicide risk factors included frequently or always counseling about the safer storage of firearms in the home (odds ratio [OR ], 5.3; 95% confidence interval [CI], 2.8-10.2); agreeing or strongly agree ing that they were sufficiently trained and knew how to screen for risk fac tors (OR, 3.2; 95% CI, 1.7-6.3); agreeing or strongly agreeing that they ha d enough time during the well visit to screen for mental health problems (O R, 2.9; 95% CI, 1.6-5.3); frequently or always counseling about child passe nger safety (OR, 2.7: 95% CI, 1.6-4.7); spending more than 5 minutes in ant icipatory guidance during the well visit (OR, 2.7; 95% CI, 1.5-4.6); practi cing in an urban setting (OR, 2.3. 95% CI, 1.2-4.7); agreeing or strongly a greeing that physicians can be effective in preventing adolescent suicide a nd that what they do during an office visit may help prevent adolescent sui cide (OR, 2.0; 95% CI, 1.2-3.4); and female sex (OR, 1.9; 95% CI, 1.1-3.2). Conclusions: Despite the substantial proportion of primary care providers w ho encountered suicidal adolescent patients, most providers still do not ro utinely screen their patients for suicidality or associated risk factors. M ore training is needed and desired by the survey respondents. Patient confi dentiality issues must be addressed. Development and widespread use of a sh ort, easily administered, reliable, and valid screening tool are recommende d to help busy clinicians obtain more complete information during all visit s.