A Qualitative Study Exploring Adolescent and Caregiver Perspectives of Emergency Department Response After a Positive Suicide Screen

Abstract

Study objective

As a safety net for adolescents, the emergency department (ED) is considered an opportune setting for suicide screening and response (ie, safety assessments, brief interventions, and referrals). This study explored adolescent and caregiver perspectives on the ED’s response when nonacute suicide risk was identified during universal screening.

Methods

This was a qualitative study of adolescents who completed the Ask Suicide-Screening Questions (ASQ) in the ED and/or their caregiver. Our institution performs universal suicide screening with the ASQ for all ED patients aged 10 or more years. We conducted semistructured interviews with adolescents (13 to 17 years) who had a “nonacute positive” ASQ (defined as “yes” to questions 1 to 4 on the ASQ without current thoughts of suicide), and/or their caregiver. Interviews were scheduled after ED discharge and occurred from October 2023 to June 2024. Interviews were audio-recorded, transcribed, and coded in ATLAS.ti. Content analysis was used to identify salient themes. The analytic team diagrammed each participant’s story to augment the analysis.

Results

We completed 17 interviews (8 adolescents and 9 caregivers). Three primary themes were identified: (1) responses by ED clinicians are lacking, confusing, and inconsistent; (2) ED responses should be tailored, well timed, private, and autonomous; and (3) resources provided by the ED should empower adolescents and caregivers moving forward. Participants recommended resources that overcome barriers to care and standardized ED interventions to better support patients and families.

Conclusion

In this study, the ED response to nonacute suicide risk was described as inadequate. Participants recommended additional resources to safely manage suicidal thoughts and navigate mental health treatment.