Evaluating Iatrogenic Risk of Suicide Screening Program

New York State Psychiatric Institute, New York NY

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Abstract

A pervasive concern among the lay public and school personnel about screening surveys is whether asking a youngster about suicidal thoughts and behavior may actually trigger subsequent suicidal ideation and behavior - the common belief that asking about suicide "puts ideas into the heads" of youngsters. There is no direct empirical basis on which to support or repudiate this concern. The present proposal focuses on this serious potential risk of screening programs, which must be addressed before a large-scale implementation of this community-based intervention should be included in a public health suicide prevention initiative. A randomized experimental design with repeated measures will be conducted within the context of a two-stage screening strategy. An ecologically valid setting (high schools) will be employed, rather than a laboratory setting, to enable the generalization of the findings to the situations where the suicide screening programs take place. A two-stage screening program will be conducted in seven high schools in Suffolk and Westchester counties in New York State. Students within each high school will be randomized to either an experimental group or a control group. The experimental group (N=1,000) will receive a 1st stage screening survey with a set of questions assessing suicidal ideation and behavior; the control group (N=1,000) will receive the 1st stage survey without the set of suicide questions. A measure of transient mood states will be given at the beginning and end of the 1st stage survey to assess psychological distress. More persistent distress will be assessed during a 2nd stage survey, administered 2 days after the 1st stage screening survey. A particular focus of investigation will be the impact of the screening survey on high-risk students, such as depressed or substance abusing youngsters or those with a past history of suicide attempts The results of the present study will either allay fears that are impeding the implementation of these screening programs, or underscore a serious problem that needs to be addressed. This information will be used to guide the development of more safe and effective school-based suicide prevention/intervention programs.