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Gould MS, Marrocco FA, Kleinman M, et al. Evaluating Iatrogenic Risk of Youth Suicide Screening Programs: A Randomized Controlled Trial. JAMA. 2005;293(13):1635–1643. doi:10.1001/jama.293.13.1635
Author Affiliations: Division of Child and
Adolescent Psychiatry (Dr Gould, Mss Mostkoff and Cote, and Mr Thomas) and
Department of Epidemiology (Dr Gould), Columbia University and New York State
Psychiatric Institute (Drs Gould and Marrocco, Ms Kleinman, and Mr Davies),
New York, NY.
Context Universal screening for mental health problems and suicide risk is at
the forefront of the national agenda for youth suicide prevention, yet no
study has directly addressed the potential harm of suicide screening.
Objective To examine whether asking about suicidal ideation or behavior during
a screening program creates distress or increases suicidal ideation among
high school students generally or among high-risk students reporting depressive
symptoms, substance use problems, or suicide attempts.
Design, Setting, and Participants A randomized controlled study conducted within the context of a 2-day
screening strategy. Participants were 2342 students in 6 high schools in New
York State in 2002-2004. Classes were randomized to an experimental group
(n = 1172), which received the first survey with suicide questions,
or to a control group (n = 1170), which did not receive suicide
Main Outcome Measures Distress measured at the end of the first survey and at the beginning
of the second survey 2 days after the first measured on the Profile of Mood
States adolescent version (POMS-A) instrument. Suicidal ideation assessed
in the second survey.
Results Experimental and control groups did not differ on distress levels immediately
after the first survey (mean [SD] POMS-A score, 5.5 [9.7] in the experimental
group and 5.1 [10.0] in the control group; P = .66)
or 2 days later (mean [SD] POMS-A score, 4.3 [9.0] in the experimental group
and 3.9 [9.4] in the control group; P = .41),
nor did rates of depressive feelings differ (13.3% and 11.0%, respectively; P = .19). Students exposed to suicide questions
were no more likely to report suicidal ideation after the survey than unexposed
students (4.7% and 3.9%, respectively; P = .49).
High-risk students (defined as those with depression symptoms, substance use
problems, or any previous suicide attempt) in the experimental group were
neither more suicidal nor distressed than high-risk youth in the control group;
on the contrary, depressed students and previous suicide attempters in the
experimental group appeared less distressed (P = .01)
and suicidal (P = .02), respectively, than
high-risk control students.
Conclusions No evidence of iatrogenic effects of suicide screening emerged. Screening
in high schools is a safe component of youth suicide prevention efforts.
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