Preliminary Validity for a Brief Caregiver-Report Screener for Suicidal Thoughts and Behaviors in Children Under Age 8.

Objective: Children as young as preschool age can experience suicidal thoughts and behaviors (STBs). Despite calls for increased youth suicide risk screening and assessment, we lack tools for identifying the youngest children experiencing STBs who might be at heightened risk for suicide, self-harm, and related distress. Clinician and caregiver skepticism about children's ability to self-report STBs and concerns about negative effects of directly asking children about STBs contribute to this gap. A caregiver-report measure for STBs can address these concerns, offering providers a much-needed tool for assessing STBs in young children. Method: A 4-item caregiver-report suicide risk screener was developed and administered by phone to caregivers of 80 children ages 4 to 7 years (mean [SD] age =6.06 [1.12] years) from diverse sociodemographic backgrounds. Approximately 3 weeks later, caregivers and children independently completed in-person age-appropriate clinical diagnostic interviews to assess STBs. Children with a history of STBs were oversampled. Sensitivity and specificity of positive screens (caregiver endorsed at least 1 item), relative to STBs detected in the diagnostic interview, were calculated to assess the psychometric properties of the screen. Results: Of the 80 suicide risk screeners administered, 18 were positive. Relative to diagnostic interviews with caregivers, the caregiver-STBs screener showed 85% sensitivity and 98.3% specificity for detecting STBs risk. Relative to diagnostic interviews with either caregiver or child, the screener showed 68% sensitivity and 98.2% specificity, and relative to child-only interviews, the screener showed 50% sensitivity and 80% specificity. Conclusion: The caregiver-STBs screener for children under age 8 demonstrates favorable psychometric properties compared with a reference standard. If further validated, this screener could offer clinicians a new brief tool to assess suicide risk in young children. Its high specificity suggests that positive screens should be taken seriously as indicators of risk, warranting further follow-up. Diversity & Inclusion Statement: We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. We worked to ensure that the study questionnaires were prepared in an inclusive way. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. One or more of the authors of this paper received support from a program designed to increase minority representation in science. We actively worked to promote sex and gender balance in our author group. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. While citing references scientifically relevant for this work, we also actively worked to promote sex and gender balance in our reference list. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list.