School-based screening for suicide risk: Balancing costs and benefits

Michelle Scott, Holly Wilcox, Yanling Huo, J. Blake Turner, Prudence Fisher, David Shaffer

Research output: Contribution to journalArticlepeer-review

15 Scopus citations


Objectives. We examined the effects of a scoring algorithm change on the burden and sensitivity of a screen for adolescent suicide risk. Methods. The Columbia Suicide Screen was used to screen 641 high school students for high suicide risk (recent ideation or lifetime attempt and depression, or anxiety, or substance use), determined by subsequent blind assessment with the Diagnostic Interview Schedule for Children. We compared the accuracy of different screen algorithms in identifying high-risk cases. Results. A screen algorithm comprising recent ideation or lifetime attempt or depression, anxiety, or substance-use problems set at moderate-severity level classed 35% of students as positive and identified 96% of high-risk students. Increasing the algorithm's threshold reduced the proportion identified to 24% and identified 92% of high-risk cases. Asking only about recent suicidal ideation or lifetime suicide attempt identified 17% of the students and 89% of high-risk cases. The proportion of nonsuicidal diagnosis-bearing students found with the 3 algorithms was 62%, 34%, and 12%, respectively. Conclusions. The Columbia Suicide Screen threshold can be altered to reduce the screen-positive population, saving costs and time while identifying almost all students at high risk for suicide.

Original languageEnglish (US)
Pages (from-to)1648-1652
Number of pages5
JournalAmerican journal of public health
Issue number9
StatePublished - Sep 1 2010

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health


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