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Ann Emerg Med. 2019 Jul;74(1):11-16. doi: 10.1016/j.annemergmed.2018.10.029. Epub 2018 Nov 28.

Utility of the "No Response" Option in Detecting Youth Suicide Risk in the Pediatric Emergency Department.

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University of Cincinnati College of Medicine, OH.
Department of Emergency Medicine and Cincinnati Children's Hospital Medical Center, OH.
The Research Institute at Nationwide Children's Hospital, Columbus, OH.
University of California-San Francisco Benioff Children's Hospital, San Francisco, CA.



We examine the characteristics of adolescents who select "no response" on a suicide screening instrument.


This study used a preexisting data set containing records of 3,388 patients aged 12 to 17 years who completed a suicide screen after presenting to the emergency department with nonpsychiatric complaints. Respondents who answered no response to at least one item without any yes responses were assigned to the no response group (n=58), whereas respondents who selected yes for any question (n=167) were assigned to the yes group. Researcher and mental health provider notes were analyzed to determine suicide risk level, presence of referral, and readiness to engage in treatment.


Suicide risk and need for mental health referral were substantial for both groups. Clinically significant risk was identified for 84.5% of the no response group and 93.4% of the yes group, with documentation of suggested mental health referral present for 50.0% and 65.1%, respectively. Individuals in the no response group were more likely to be in 1 of the 2 earliest stages of readiness for treatment engagement (40.9% compared with 25.7% of adolescents in the yes group).


To our knowledge, this is the first study to explore the relationship between a no response answer on a tablet-based screening instrument and risk for suicide as determined by a mental health provider. Although preliminary, this work indicates that youths who answer no response on suicide screening items are at elevated risk and may benefit from further evaluation or receipt of information on services. Further research is needed to better understand this population and their subsequent suicide risk.

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