Evaluating Iatrogenic Risk of Youth Suicide Screening Programs

Commission 1 and the Children's Mental Health Screening and Prevention Act 2 recommend increased screening for suicidality and mental illness.The recent enactment of the Garrett Lee Smith Memorial Act 3 further supports the development of youth suicide prevention and intervention programs.Despite the proliferation of screening programs in recent years (eg, Signs of Suicide, 4 Teen-Screen 5 ), the current debate about possible iatrogenic effects of other suicide preventive interventions, 6,7 and the belief that prevention programs may "spur troubled youngsters to try suicide," 8 the potential harm of screening for suicide remains unstudied. 9,10creening strategies are based on the valid premise that suicidal adolescents are underidentified [11][12][13][14][15] ; have an active, often treatable, mental illness [16][17][18] ; and exhibit identifiable risk factors. 11Evidence for the clinical validity and reliability of school-based screening procedures has recently emerged.Use of the Suicidal Ideation Questionnaire (SIQ) in a midwestern US high school yielded a sensitivity ranging from 83% to 100%, with specificity from 49% to 70%. 19The Suicide Risk Screen's use among 581 students in 7 high schools had a sensitivity ranging from 87% to 100%, with specificity from 54% to 60%. 20Among 2004 teenagers from 8 New York metropoli-