Zero Suicide Quality Improvement: Developmental and Pandemic-Related Patterns in Youth at Risk for Suicide Attempts

ABSTRACT

The Zero Suicide (ZS) approach to health system quality improvement (QI) aspires to reduce/eliminate suicides through enhancing risk detection and suicide prevention services. This first report from our randomized trial evaluating a stepped care for suicide prevention intervention within a health system conducting ZS-QI describes (1) our screening and case identification process, (2) variation among adolescents versus young adults, and (3) pandemic-related patterns during the first COVID-19 pandemic year. Between April 2017 and January 2021, youths aged 12–24 years with elevated suicide risk were identified through an electronic health record (EHR) case-finding algorithm followed by direct assessment screening to confirm risk. Eligible/enrolled youth were evaluated for suicidality, self-harm, and risk/protective factors. Case finding, screening, and enrollment yielded 301 participants showing suicide risk indicators: 97% past-year suicidal ideation, 83% past suicidal behavior; and 90% past non-suicidal self-injury (NSSI). Compared to young adults, adolescents reported more past-year suicide attempts (47% vs. 21%, p < .001) and NSSI (past 6 months, 64% vs. 39%, p < .001); less depression, anxiety, posttraumatic stress, and substance use; and greater social connectedness. Pandemic onset was associated with lower participation of racial-ethnic minority youths (18% vs. 33%, p < .015) and lower past-month suicidal ideation and behavior. Results support the value of EHR case-finding algorithms for identifying youths with potentially elevated risk who could benefit from suicide prevention services, which merit adaptation for adolescents versus young adults. Lower racial-ethnic minority participation after the COVID-19 pandemic onset underscores challenges for services to enhance health equity during a period with restricted in-person health care, social distancing, school closures, and diverse stresses.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/23794925.2023.2208382.

Disclosure statement

The authors have declared that they have no competing or potential conflicts of interest. Dr Asarnow has received grant, research, or other support from the National Institute of Mental Health, the Patient Centered Outcome Research Institute, the American Foundation for Suicide Prevention, the Substance Abuse and Mental Health Services Administration, the American Psychological Foundation, the Society of Clinical Child and Adolescent Psychology (Division 53 of the APA), and the Association for Child and Adolescent Mental Health. She has served as a consultant on quality improvement for depression and suicide/self-harm prevention, serves on the Scientific Council of the American Foundation for Suicide Prevention, the Scientific Advisory Board of the Klingenstein Third Generation Foundation, and the Editorial Committee for the Annual Review of Clinical Psychology.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

This work was supported by R01 MH112147 awarded by the National Institute of Mental Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.