Asking Preadolescents About Suicide Is Not Associated With Increased Suicidal Thoughts

Objective: Rising rates of suicidal thoughts and behaviors (STBs) in preadolescents make suicide-risk screening in this age group critical to reduce harm. Although screening appears generally safe for youth aged 12 years of age and older, effects in preadolescents remain unknown. This study tested iatrogenic effects of repeated suicide-risk screening in 2 groups of preadolescents (8-12 years of age): a lower-risk group with no prior STBs, and a higher-risk group who had experienced STBs. Method: The Ask-Suicide Screening Questions (ASQ) screener, modified to query suicidal thoughts over the prior week, was administered to 194 preteens from the Pediatric Suicidality Study (PED-SI) over 12 months. PED-SI is a study of preschool-onset depression following children recruited at ages 3 to 6 years for depression and nondepressed peers. Lower-risk preadolescents (n = 68) completed monthly screens, whereas higher-risk preadolescents (n = 124) completed weekly screens, administered remotely via text or e-mail. We examined correlations between screen completion rates and positive screens, changes in positive screens over time, and whether previous screen completion predicted a positive future screen. Bayes factors assessed for meaningfulness of null effects. Results: A total of 192 preadolescents (mean age = 10.13 years; 63% boys, 37% girls; 79.2% White, 8.9% Black, 9.9% Multiracial, 2.1% Asian; 7.3%, Hispanic) completed at least one screen. Findings from inferential statistics and supported by Bayes factors indicated no evidence that repeated screening increased suicidal thoughts in either group. In the lower-risk group, positive screens were rare (1.6%), with no significant increases over time. In the higher-risk group, 7% of screens were positive, but this frequent screening did not exacerbate suicidal thoughts. Conclusion: Suicide-risk screening appears to be safe for preadolescents. Clinicians can proceed with screening preadolescents with increased confidence that the benefits outweigh the risks. Plain language summary: This study examined the effects of repeated suicide-risk screens on rates of suicidal thoughts and behaviors in preadolescents. Using the Ask-Suicide Screening Questions screener, the study followed 194 preadolescents from the Pediatric Suicidality Study over 12 months, with lower-risk children screened monthly and higher-risk children screened weekly. Results showed no evidence that repeated screening increased suicidal thoughts among either group of preteens. These findings provide reassurance that suicide-risk screening appears safe for preteens, allowing clinicians to screen with increased confidence that the benefits outweigh the risks.