Influential panel raises doubts on youth suicide screening

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An influential U.S. group is raising doubts about routine suicide screening for children and teens even as others call for urgent attention to youth mental health.

In draft guidance posted Tuesday, the U.S. Preventive Services Task Force said there's not enough evidence to recommend routinely screening who show no obvious signs of being suicidal. The document is open for public comment until May 9, and opposing voices are already weighing in.

Many experts agree with the group's assessment that more research is urgently needed but argue that there's no evidence that screening—asking kids if they've ever considered or attempted suicide—could cause harm.

"In the meantime, what are you going to do with this crisis? You cannot turn a blind eye,'' said psychologist Lisa Horowitz of the National Institute of Mental Health.

The task force is an independent group of doctors and other experts that creates guidelines for prevention services in primary care settings, based on an analysis of research. The group's final recommendations often mirror its draft guidance. Insurance coverage decisions are often based on its advice.

The draft guidance pertains to screening in pediatricians' offices and similar settings for kids up to age 18.

In 2020, suicide was the second-leading cause of death for ages 10 to 14, and the third leading cause for ages 15 to 19, according to data from the federal Centers for Disease Control and Prevention.

Abundant reports suggest kids' mental health has suffered during the pandemic, with troubling numbers of suicide attempts and increases in depression, anxiety, eating disorders and other signs of distress.

"Certainly, we all share the same concern about wanting to minimize this risk for and to intervene effectively so that we can prevent these consequences,'' said task force member Martha Kubik, a professor of nursing at George Mason University. But she said suicide screening in kids who aren't obviously troubled could lead to stigma and needless anxiety.

The task force's draft document recommends anxiety screening for ages 8 to 18, and echoes its previous advice for depression screening starting at age 12. Kubik said depression screening may catch some suicidal kids.

Suicide prevention experts say there's a common misconception that asking kids about suicide will plant the idea in their minds. They argue that open conversations will reduce suicide stigma and let kids know parents and trusted adults care about their wellbeing.

"This report may actually set the field back,'' said Dr. Christine Moutier of the American Foundation for Suicide Prevention.

Just last month, the foundation and the American Academy of Pediatrics backed suicide screening for ages 12 and up, and for kids aged 8 to 11 when there are concerns.

Last year, the pediatrics group and two others declared children's health a national emergency worsened by the pandemic. And in January, the government issued updated Affordable Care Act preventive care guidelines that call for universal screening for suicide risk for ages 12 to 21.

The suicide of a 12-year-old Elkhart, Indiana, girl last month left her close-knit family reeling and wondering if they'd missed any signs. Rio Allred was a witty, bright-eyed seventh grader with a wicked laugh who loved books, sketching and video games.

They knew she was bothered by merciless bullying about her alopecia, an autoimmune disease that causes hair loss. She developed it during the pandemic, shaved her head and only sometimes wore wigs or a hat. The family complained to school authorities and gave Rio a choice of transferring or home-schooling, but she wanted to stay put, said her mom, Nicole Ball.

"She put on such a brave face," Ball said. "I never thought it would get to this point."

The family talked openly about tough subjects including suicide, and Ball says Rio had recently gone to a school counselor, worried about one of her friends self-harming.

But Ball says she thinks routine by "somebody that's trained, on the outside looking in,'' might pick up things kids don't openly share, or signs that parents overlook.

The family has launched an anti-bullying campaign, and Ball says she's sure Rio would approve.

"I always said she would change the world,'' she said. "I hate that it's this way."


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