School-based universal screening for suicide risk


Dr Swati Y Bhave, Adjunct Professor in Adolescent Medicine; Dr D Y Patil Medical College, & Dr D Y Patil Vidyapeeth, Pune; Sr. consultant, Adolescent Pediatrics & Head-In-charge of Adolescent Wellness Clinic, Jehangir Hospital Pune    04 February 2023

Universal screening of students could identify a large number of students at high risk for suicide resulting in increase in commencement of mental health treatment, according to the findings of a new research published in The Journal of Pediatrics.1


The effectiveness of screening adolescents for suicide risk was evaluated in this secondary analysis of the SHIELD (Screening in High Schools to Identify, Evaluate and Lower Depression) trial. The study also examined if risk screening would increase initiation of mental health services. For this, 12,909 students from 14 Pennsylvania high schools were enrolled. 46% students were female and 43% Hispanic or non-Hispanic Black.


Students in Grade 9 and 11 in seven schools underwent targeted screening, while those in grades 10 and 12 received universal screening using the Patient Health Questionnaire-9 (PHQ-9). Students in grades 10 and 12  from the remaining seven schools  received targeted screening and those in grades 9 and 11 received universal screening. At risk students were referred to the mandatory Student Assistance Program (SAP) to determine the need for follow-up.


Researchers identified 718 students (5.6%) at risk for suicide. These included 622 students in the universal screening group and 96 in the targeted screening group. A total of 143 students in the universal screening group required follow-up versus 16 in the targeted screening group. The risk of suicide was found to be 7.1-times higher among adolescents in the universal screening group. They were also 7.8 times more likely to require follow-up with 4 times greater likelihood of starting mental health treatment.


This study demonstrates that rather than behavior-based targeted screening, universal screening, where everybody is screened, yields greater detection of adolescents at high risk and also allows initiation of treatment. The use of PHQ-9, which is a screening tool for depression, could successfully identify students at risk for suicide and also increased start of therapy. A suicide-specific risk assessment using tools like Ask Suicide Screening Questions (ASQ), however, would further enhance the accuracy of screening. It further shows that schools make for better settings for screening since a very small percentage of adolescents visit their primary care provider for preventive care and therefore are likely to be missed. These findings have implications for policy makers and provide evidence for strengthening mental health screening programs in schools.




  1. Sekhar DL, et al. Adolescent suicide risk screening: a secondary analysis of the SHIELD randomized clinical trial. J Pediatr. 2022 Dec;251:172-177. doi: 10.1016/j.jpeds.2022.07.036.

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