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