SAFER: Suicide Assessment and Follow-up after Emergency Department Release for 8-12-Year-Old Children - Project Summary Despite widespread prevention efforts, suicide is the second leading cause of death among teens and young adults, and increasingly, suicide has become a public health concern among children <12-years-old. The emergency department (ED) often serves as the primary contact point for youth to receive care for suicide risk. Yet, among adolescents receiving inpatient or ED care, 10% will attempt suicide and 30% will exhibit suicidal behaviors within 3 months of discharge. This study aims to map the landscape of early suicide risk among children seeking ED care to facilitate the development of actionable intervention targets/methods. We will recruit N=250 children (8-12 years old) via multiple pediatric EDs (NewYork-Presbyterian, Montefiore) with diverse catchment areas and patients with typically less access to care. Children and their guardian will complete clinical interviews to probe suicide and related risk factors. Electronic health records will be probed for structured data on risk factors as well as using natural language processing of clinician notes. Children will also complete brief MRI scanning at baseline to assess brain structure (using clinically relevant MRI protocols) and midbrain dopamine (novel neuromelanin MRI). We focus on brief, clinically relevant sequences that are readily harmonized across site/scanners and can be assessed from brain imaging ordered as part of clinical practice. During a 6-month follow-up period, guardians will complete low-burden, weekly check-in surveys (via their personal smartphone) as well as brief 3- and 6-month remote interviews to characterize fluctuations in their child’s suicide risk, difficulties with safety plans, changes in risk factors (e.g., sleep, familial disruptions, impulsive behaviors), and any subsequent of suicide behaviors. These multi-faceted data will be leveraged to examine clinical and neural risk factors that predict post- discharge suicide events (e.g., suicide attempts, return to ED, or psychiatric hospitalization) in high-risk children. Weekly parental reports will help to map post-discharge changes over 6 months related to suicide events post- discharge. We anticipate that greater psychiatric comorbidity, sleep problems, and family stress will be critical risk factors for post-discharge suicide outcomes. Further, smaller prefrontal, striatal, and cingulate volumes relative to population levels as well as reduced midbrain dopamine will predict greater risk for future suicide events. Difficulty implementing safety plans, maintaining regular routines (e.g., bedtimes, home environment), and excessive family conflict in the post-discharge period will relate to subsequent suicide events. This work will inform the development of new screening (to ensure that key risk factors are clearly ascertained and documented), improve discharge plans for clinicians, and help families detect risk post-discharge. Improving care for high-risk young children is an urgent priority. Findings from this work may be able to address suicide risk in other settings (e.g. primary care) and populations.
