Level of behavioral health integration and suicide risk screening results in pediatric ambulatory subspecialty care

This study aimed to characterize suicide risk screening results for youth in pediatric ambulatory subspecialty clinics. The Ask Suicide-Screening Questions was administered to patients ages 9–24 years in 12 subspecialty clinics to assess suicide risk, determined by suicide ideation/behavior. The SAMSHA-HRSA standard framework for integrated health was used to categorize each clinic's level of behavioral health integration. 6365 patients completed 7440 suicide risk screens; 6.2% of patients screened positive at their initial screen and 4.1% at subsequent annual screens. There was no dose-response pattern between increasing level of integration and decreasing likelihood of a positive suicide screen. Youth identifying as gender expansive were 3.1 times (95% CI [2.0, 4.9]) more likely to screen positive as compared to cisgender youth, adjusted for age, gender, race/ethnicity, screen type, year, and clinic integration level. Results surrounding disparities in suicide risk based on gender identity underscore the importance of further investigating how to optimally identify and manage high-risk, often understudied youth at suicide risk. •Suicide risk among 6365 youth with chronic medical conditions were examined.•Among initial screens, 6.2% of patients had positive screen for suicide risk.•Levels of behavioral health integration were related to suicide risk.•Youth identifying as gender expansive reported higher suicide risk.•The likelihood of positive screen was half at rescreens compared to initial screens.