519 - Should I go or should I stay now? Influence of caregiver presence on suicide risk screening outcomes
Monday, April 28, 2025
7:00am – 9:15am HST
Publication Number: 519.6970
Shane J. Sacco, University of Connecticut School of Medicine, Farmington, CT, United States; Kristen Volz, Connecticut Children's Medical Center, Hartford, CT, United States; Steven C.. Rogers, Connecticut Children's Medical Center, Hartford, CT, United States
Pediatric Emergency Medicine Physician Connecticut Children's Medical Center Hartford, Connecticut, United States
Background: Suicide is a leading cause of death in youth aged 10 to 18. In efforts to prevent suicides, the Joint Commission requires suicide risk screening in healthcare settings. Screening shows prognostic value in predicting suicide risk but challenges in implementation remain. One challenge is determining whether patient privacy may impact screening results, for instance when a caregiver is present. Some patients may be hesitant to divulge risk in front of their caregiver. However, caregiver presence may also provide positive social support, a known protective factor against suicide behavior. Objective: To determine the impact of caregiver presence on suicide risk screening and subsequent suicidal behavior. Design/Methods: We studied 14,455 patients 10- to 18-year-olds that had suicide screening in a large urban pediatric emergency department presenting with medical complaints (Figure 1). We assessed individual associations between demographics, encounter details, parent presence, risk results, and subsequent suicide attempts. We then tested a pathway model linking parent presence to risk results and risk results to suicide attempts, including a direct pathway between parent presence and suicide attempts. Pathways were adjusted for covariates. Results: Patients were half male (49%), 14-18 years old (54%), and covered by Medicaid (53%). Most patients were White (39%) or Hispanic (35%). There were 2,765 patients that had their parent in the room (19%) during screening, 1,096 that scored positive for suicide risk (8%), and 185 that later attempted suicide (1%). Patients who had their parent in the room were 0.8 times likely to score positive for suicide risk and 0.6 times likely to return to the PED with a suicide attempt (ps < 0.04). Patients with positive risk scores were 7.7 times likely to attempt suicide (p < 0.001). Relations did not meaningfully differ, while slightly weaker, when entered into the pathway model (Table 1).
Conclusion(s): The influence of parent presence during screening remains unclear, in that, it was related to both reduced test positivity rates and suicide attempt rates. Future studies may clarify this further, by inquiring whether presence was requested by the parent or patient or collecting relationship quality data from the patient. Patient privacy from parents appears more complex than once thought and perhaps the recommendation to separate patients from parents during screening may not be uniformly beneficial to patient care or health.
