Screening and Evaluation of Pediatric Suicide Risk

With pediatric suicide rates on the rise, early and effective screening is crucial. Among adolescents aged 12-18, nearly 1 in 5 experiences suicidal ideation—and primary care providers are often the first point of contact. Since many young people don't openly discuss their struggles, proactive screening can uncover hidden risks and create opportunities for timely intervention.

Who Should Be Screened?

The American Academy of Pediatrics (AAP) recommends depression and suicide risk screening for all children 12 years of age and older at well-child visits and as clinically indicated.  Here are specific recommendations for suicide screening based on age:

• Ages 12 and older: Universal suicide screening during well-child visits
• Ages 8-11: Screen when presenting with behavioral health chief complaints if patient/parent raises concern or if the patient displays warning signs for suicidal thoughts/behaviors
• Under age 8:  Screening is not indicated unless warning signs for suicidal thoughts/behaviors are present

Validated Screening Tools

Self-administered forms can help adolescents disclose thoughts they might hesitate to verbalize. Recommended, validated screening tools include:

• Patient Health Questionnaire-9 Adolescent Version (PHQ-9A)
• Ask Suicide-Screening Questions (ASQ)—designed for ages 8+
• Suicide Behavior Questionnaire-Revised (SBQ-R)

How to Approach the Conversation

Creating a safe, judgment-free environment is key. Adolescents may feel more comfortable discussing their feelings privately without a parent present. Clinicians should explain confidentiality limits upfront: “What you share is private unless I need to help keep you or someone else safe.”

Research shows that asking about suicide doesn’t increase ideation—instead, it provides an opportunity for at-risk children to open up. Open-ended, empathetic questions may encourage patients to share:

• “Can you tell me how you’ve been feeling lately?”
• “Have you ever felt like you didn’t want to be here anymore?”
• “Do you ever think about hurting yourself or ending your life?”

If a child is reluctant, ask if a trusted friend, parent, or teacher knows how they’re feeling. Framing the question this way, “If your best friend was here, would they be worried about you?” can make it easier for children to express their emotions.

Key Warning Signs

A mnemonic to help remember key warning signs for suicide is: “IS PATH WARM.”

• Ideation: talking about or threatening to harm or kill oneself, looking for ways to kill oneself
• Substance abuse
• Purposelessness
• Anxiety: worry, fear, or agitation
• Trapped: feeling like there is no way out of a bad situation
• Hopelessness
• Withdrawal or feeling isolated from friends, family, and society
• Anger
• Recklessness
• Mood changes

What Comes After Screening?

Identifying suicide risk is only the beginning. For high-risk cases, such as those with a concrete plan, recent attempt, or severe hopelessness, immediate crisis intervention is necessary. This may involve emergency mental health evaluation or hospitalization.

For lower-risk patients without active suicidal intent, outpatient mental health referrals and safety planning are essential. 

Safety plans should:

• Identify personal warning signs
• Outline calming strategies
• List trusted contacts (both personal and professional)
• Include a plan for removing lethal means (e.g., firearms, medications)
• Provide crisis resources like 988 (Suicide & Crisis Lifeline) or Crisis Text Line (text “HOME” to 741741)

Parents should be involved in safety planning, ensuring they understand how to monitor their child’s well-being and secure potentially harmful items.

Effective screening and evaluation of suicide risk can save lives. By asking the right questions, using validated tools, and creating a compassionate, safe space for adolescents to share, we can uncover risks that might otherwise remain hidden. Every conversation counts—and early intervention can make all the difference.

For more about screening and evaluation of pediatric suicide risk, listen to our Peds RAP episode, "MOCA: Understand screening, evaluation, and management of suicide risk."