Suicide Risk Screening Must Begin in Adolescent Primary Care Setting

Michelle Falci | March 20, 2024  Clinical Advisor

By creating a standardized framework for screening adolescent patients for suicide risk, primary care providers can be instrumental in identifying youth who have mental health concerns.

The data paints a bleak picture. In the United States, suicide is the second leading cause of death among teenagers and young adults aged 15 to 24 years. Half of adolescents who committed suicide were seen by a health care provider within 4 weeks of their death. Although approximately 3.7 million adolescents have reported having major depressive episodes, the vast majority of patients don’t seek help.

The solution: implementing the Ask Suicide-Screening Questions (ASQ), a screening tool for suicide risk among adolescent patients. Implementing routine screening will help clinicians properly manage mental health issues in the pediatric primary care setting, according to research presented at the National Association of Pediatric Nurse Practitioners (NAPNAP) National Conference on Pediatric Health Care held March 13 to 16, 2024, in Denver, Colorado.

“The rise in adolescent suicide in the United States is certainly alarming and pediatric nurse practitioners [PNPs] can be instrumental in ensuring that all adolescents in their population are appropriately screened,” said Mary Koslap-Petraco, DNP, PPCNP-BC, CPNP, FAANP, who reviewed the poster for Clinical Advisor.

This quality improvement initiative measured the effects of implementing the ASQ screening toolkit over an 8-week intervention period in the fall and winter of 2023. Adolescents presenting for a well child visit during the study period received the ASQ and the Patient Health Questionnaire (PHQ-9).

The rise in adolescent suicide in the US is certainly alarming and pediatric nurse practitioners can be instrumental in ensuring that all adolescents in their population are appropriately screened.

Researchers aimed to monitor the number of referrals for positive screens and accuracy of appropriate billing in electronic health records (EHR) after educating staff and providers (2 pediatric nurse practitioners (PNPs), 1 physician associate, 2 medical assistants) on the youth suicide risk screening pathway and updated clinic resource list.

If a patient’s screening came back positive, providers used the toolkit and pathway to determine an appropriate management plan for the patient.

After providers attended education sessions, 80% of adolescents who presented for a well visit were offered screening; all patients whose screenings came back positive were given resources (n=5), referrals (n=2), or both (n=2). All screenings were billed appropriately in EHR.

The results of this project indicate that there are opportunities to assist adolescents and their families with managing mental health concerns in the primary care setting.

“While there was an 80% positive outcome only 14 children were reviewed so conclusions really cannot be drawn due to the small sample size,” Dr Koslap-Petraco said. “It would have been very interesting to see if the results were the same if more children were included in the project.”

The results from this study were limited by small clinic size and a short implementation period, as well as lack of follow-up on referrals.

By continuing provider education on mental health issues in primary care, the study authors hope to expand this framework to other clinic locations and develop processes for multiple screenings and following up on referrals.

Visit Clinical Advisor’s conference section for more coverage of NAPNAP 2024.


Cooper E, Carrico C, Allen K. Increasing suicide screening in a pediatric primary care clinic: a quality improvement project. Presented at: NAPNAP national conference; March 13-16, 2024; Denver, CO.