Universal screening for suicide risk revealed a high proportion of youth in need of mental health services at one hospital
Washington, D.C.— Nearly 80% of emergency department encounters involving transgender or gender diverse youth ages 10 and older screened positive for suicide risk while seeking treatment at a Chicago emergency department over a 3.5-year period, according to research presented during the 2023 AAP National Conference & Exhibition at the Walter E. Washington Convention Center.
The abstract, “Suicidal Ideation in Transgender and Gender Diverse Youth in the Emergency Department,” examines data provided after universal suicide screening was implemented in the Emergency Department for all youth 10 and older who presented at Ann and Robert H. Lurie Children’s Hospital of Chicago between September 2019-August 2022. Researchers found that in 24% of 12,112 ED encounters, patients screened positive for suicide risk. Using the electronic medical record, the author identified that of 565 encounters by transgender and gender diverse youth, positive suicide risk was identified in 78% of encounters, with 10% of encounters by transgender and gender diverse youth endorsing active suicidal ideation at the time of ED presentation.
“Unfortunately, these findings did not surprise me as I routinely see transgender and gender diverse youth struggling with their mental health in my practice as a clinical psychologist,” said abstract author Amanda Burnside, PhD Attending Pediatric Psychologist at Ann & Robert H. Lurie Children’s Hospital of Chicago and Assistant Professor of Psychiatry and Behavioral Sciences at Northwestern University Feinberg School of Medicine. “Common contributing factors include bullying and discrimination, and it is imperative that we continue to support these youth.”
Compared to cisgender youth, transgender and gender diverse youth were 5.35 times more likely to screen positive for suicide risk.
"We should work to ensure that all youth are routinely screened for suicide risk across every health care setting,” Dr. Burnside said. “We need to develop robust systems to connect youth who screen positive with mental health services."
More than 77% of emergency department encounters by transgender and gender diverse youth were for a chief complaint centered on mental health, according to the research.
“Caregivers and other supportive adults should routinely check in with transgender and gender diverse youth about their mental health. Any concerns can be brought to the attention of the youth's pediatrician. The National Suicide and Crisis Line is also available as a resource 24/7 by calling 988.”
This work was supported by Stanley Manne Children’s Research Institute at Ann and Robert H. Lurie Children’s Hospital of Chicago through the Mental Health Springboard Award (2022).
Dr. Burnside is scheduled to present her research, which is below, from 4:45 p.m.- 4:55 p.m. ET Monday, Oct. 23. To request an interview, contact Julianne Bardele at JBardele@luriechildrens.org.
In addition, Dr. Burnside will be among highlighted abstract authors who will give a brief presentations and be available for interviews during a press conference from 8 -9 a.m. ET Sunday, Oct. 22 in the National Conference Press Room 102 AB. During the meeting, you may reach AAP media relations staff in the press room.
Please note: only the abstract is being presented at the meeting. In some cases, the researcher may have more data available to share with media, or may be preparing a longer article for submission to a journal.
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The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit www.aap.org. Reporters can access the meeting program and other relevant meeting information through the AAP meeting website at http://www.aapexperience.org/
Program Name: AAP National Conference & Exhibition
Submission Type: Section on LGBT Health and Wellness
Abstract Title: Suicidal Ideation in Transgender and Gender Diverse Youth in the Emergency Department
Chicago, IL, United States
Background: Suicide among transgender and gender diverse (TGD) youth represents a national crisis. One in four high school youth who identify as a sexual or gender minority attempts suicide during a 6-month period, and nearly half of these youth seriously consider attempting suicide. In healthcare settings, research involving TGD individuals has historically been limited to specialized clinic populations or youth with gender-specific diagnostic codes documented in the electronic medical record (EMR). However, this approach likely significantly underestimates the prevalence of TGD youth in healthcare settings. To bridge this gap, one study utilized an EMR keyword search strategy to identify transgender youth, but this study did not identify other youth on the gender diversity spectrum. Our objective was to develop a novel keyword-based method for identifying TGD youth in the EMR and to employ this method to identify rates of suicidal ideation among TGD youth in the emergency department (ED).
Methods: We conducted a retrospective cross-sectional study of ED encounters by youth who received suicide screening at an urban tertiary children’s hospital from September 2019-August 2022. Suicide screening was conducted using Ask Suicide-Screening Questions (ASQ). TGD youth were identified using keyword searching. If any of 9 keywords (they/them, preferred name, pronouns, male-to-female, female-to-male, nonbinary, agender, transgender, gender dysphoria) were present in the ED note, the surrounding text was extracted and manually reviewed to determine whether the text conveyed TGD status.
Results: The ASQ was administered in 12,112 ED encounters, and 1 in 4 (24%) encounters had a positive screen. We identified 565 ED encounters by 399 unique TGD youth. Thirty-one percent of ED encounters by TGD youth contained just one keyword. TGD youth ranged from 8 to 23 years old and were 43% White, 35% Latinx, 10% Black, 4% Asian, and 8% other/two or more races. Of TGD youth, 43% were publicly insured and 52% resided in a neighborhood with a “low” or “very low” Child Opportunity Index category. For TGD youth specifically, most identified ED encounters (77.5%) were for a mental health chief complaint. In 81% of TGD encounters, TGD youth screened positive on the ASQ with 10% endorsing active suicidal ideation at the time of ED presentation.
Conclusion: Use of a keyword-based method to identify TGD youth in the EMR revealed high rates of suicidal ideation, which may inform suicide prevention efforts. Future analyses will further characterize ED encounters by TGD youth, including characteristics associated with suicidal ideation and trends in rates of suicidal ideation over time. This work was supported by Stanley Manne Children’s Research Institute at Ann and Robert H. Lurie Children’s Hospital of Chicago through the Mental Health Springboard Award (2022).
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