Suicide screening in schools yields results

By Megan Rauscher

NEW YORK (Reuters Health) - School-based suicide screening can identify students at risk for suicide and other mental health problems not recognized by school professionals, new research suggests.

“School-based screening can be an integral component of a school’s mental health initiative and complement the work already being performed by school staff making for a complete program,” Dr. Michelle A. Scott, from the Division of Child and Adolescent Psychiatry, Columbia University College of Physicians and Surgeons, New York, told Reuters Health.

In the early 1990s, evidence emerged that suicide awareness programs, which did not stress the association between suicide and mental disorders like depression, were not effective and, in fact, had a negative impact on those students who had made a prior suicide attempt, Scott explained.

Unlike prior prevention efforts that require a student to come and seek help on their own, school-based screening is a proactive approach to identifying students who may be at risk for attempting suicide, she noted.

That is to say, school-based screening asks students directly about their risk factors for suicide, including thoughts of killing oneself, prior attempts, and mental health problems such as depression, anxiety and substance use. If a student is indicated to be at risk, they are further evaluated by a clinician at school to determine if an outside referral is necessary.

Scott and colleagues evaluated whether a school-based screening for suicide risk called the Columbia Suicide Screen was redundant to the work already being conducted by school staff, such as counselors, nurses and disciplinary staff.

Of 1,729 students from seven high schools in the New York area who completed the screening, 489 had a positive result, indicating that they were at risk for suicide. A total of 641 students (73 percent of those who had screened positive and 23 percent of those who screened negative) were studied further.

“This study found that school-based screening identifies students with significant mental health problems that school professionals did not already indicate being concerned about,” Scott said. “However, it should be mentioned that there were students identified by the school staff that were not identified by the screen.”

The discrepancy may arise because school professionals are aware of students with behavioral or conduct problems that may be at risk for suicide, she explained, while the screen does not ask students about behavioral or conduct problems but does inquire about problems with alcohol and drugs.

Specifically, more than one third (34 percent) of students with significant mental health problems were identified only through the school-based Columbia Suicide Screen. Thirteen percent were identified only by school professionals, and 35 percent were identified both through screening and by school professionals.

It’s also important to note, Scott said, that school-based screening and school professionals failed to identify roughly 18 percent of students at risk for suicide or mental problems.

SOURCE: American Journal of Public Health, February 2009.

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