097 - Evaluating Equity in Universal Suicide Screening: Racial/Ethnic Disparities and Effects on Emergency Department Use

Publication Number: 97.4893

Richelle L. Clifton, University of Washington School of Medicine, Seattle, WA, United States; Molly Adrian, University of Washington School of Medicine, Seattle, WA, United States

Background: Youth suicide is a critical public health issue, ranking as the second leading cause of death among young people worldwide. Youth who die by suicide often have suicidal thoughts and behaviors that can be identified in routine healthcare visits. These observations have provided broad support articulating a universal screening clinical pathway for early identification and treatment of suicidal thoughts and behaviors in health care settings.

Objective: There is limited research on how participation in universal suicide screenings varies by race and ethnicity despite documented disparities in suicide rates across racial and ethnic groups. Additionally, although universal screening aims to identify suicidal thoughts and behaviors early, there is limited knowledge about its impact on emergency mental health services use. This study aimed to address these two critical gaps in the literature.

Design/Methods: Following IRB review, data were drawn from patient medical records for ambulatory visits within a large children’s hospital system between 6/1/21, and 9/12/23, for patients aged 10 and above who presented to an in-person visit in an eligible clinic and were asked to complete a screening for suicide risk. For this study, we examined patient Ask Suicide Screening Questions (ASQ) scores, demographic information, and whether patients visited the emergency department for mental health concerns within 90 days of the suicide risk screening.

Results: 160,193 eligible visits for patients between ages 10-25 (Mage=14.35) were included in final analyses. After controlling for within patient correlations, race/ethnicity was a significant predictor of screening acceptance (Wald Chi-Square = 138.194, df = 10, p < 0.001), and screening result (Wald Chi-Square = 175.747, df = 10, p < 0.001), with differences by specific racial/ethnic background. Survival analyses indicated that there were significant differences in time to emergency department (ED) visit between screened and not screened youth (χ²(1) = 5.889, p = .015), and between youth with positive screens and negative screens (χ²(1) = 335.807, p < .001).

Conclusion(s): Racial/ethnic differences in screening acceptance and outcomes indicate disparities in mental health risk identification among youth. These findings highlight the need for culturally sensitive screening protocols to enhance engagement and ensure equitable risk identification. Additionally, results suggest that screening and outcomes may help predict acute mental health service use and needs, underscoring the value of screening for early crisis prevention and response.