If you had two minutes to screen teenagers who were potentially at risk for suicide, what four questions would you ask them? That’s the central inquiry in a study published last month by researchers at the National Institute of Mental Health. The quick screening tool they developed is as interesting for what it doesn’t include—a question about bullying—as for what it does.
The research team, led by Lisa Horowitz, tested 17 questions on more than 500 patients between the age of 10 and 21 who visited the emergency room for either psychological problems or physical illness. There is already a screening tool for teen suicide attempts that’s considered to be the gold standard in medicine, because it has held up well in multiple studies—a 30-question list called the Suicidal Ideation Questionnaire. Horowitz and her colleagues wanted to figure out whether a far shorter list of questions could come close to matching the SIQ for catching kids at risk for attempting suicide. They came up with 17 potential questions for ER doctors and nurses to try on their young patients. The four questions that matched the SIQ results almost perfectly (with 97 percent accuracy) were:
1. In the past few weeks, have you felt that you or your family would be better off if you were dead?
2. In the past few weeks, have you wished you were dead?
3. In the past week, have you been having thoughts about killing yourself?
4. Have you ever tried to kill yourself?
It makes sense that these questions in combination would screen effectively for suicide attempts: They’re either directly about suicidal thoughts or attempts, or about the kinds of thoughts that are strongly associated with depression, a major predictor for suicide. One of the other 17 questions, though, was about bullying: “In the past few weeks, have you been bullied or picked on so much that you felt like you couldn’t stand it anymore?” And what’s striking about this one is that it had the very lowest ranking among the 17, meaning it was the least likely of all 17 questions to match the predictive quality of the SIQ.
The point isn’t that there’s no link between bullying and risk for suicide. Another study in October found that children who say their peers pick on them—like children who are abused or mistreated in other ways—were significantly more likely to have suicidal thoughts than children who weren’t bullied. (The study also found the greatest risk of suicidal thinking among children who were victimized in more than one way.) What’s interesting about the December study, as Ann Haas of the American Federation for Suicide Prevention pointed out to me, is that it suggests that in a world of limited resources, bullying isn’t the factor that makes sense to focus on for suicide prevention. The key here is proportion, and understanding that suicide usually has multiple causes.
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