Adolescent Suicide Screening in Primary Care and the Role of the RN

Purpose: The purpose of this evidence-based research pilot project was to identify current practice for adolescent suicide screening in primary care and the role of the RN in this process.

Background: Suicide is the second leading cause of death among adolescents and young adults in the United States (CDC, 2019). It is crucial for nurses working in all settings, including primary care, to be able to recognize and respond to suicide risk and suicidality in the adolescent population. In individuals that died by suicide, 45% of them had a visit with their primary care physician a month before death (Hogan & Grumet, 2016). This inquiry aimed to answer the question “What does adolescent suicide screening look like in primary care and what is the role of the RN in this process?”

Methods: A multi-method approach was utilized. First, a review of literature was conducted in August 2021 using a combination of MeSH terms and Boolean operators in the following databases: CINAHL, PubMed, and SCOPUS. Next, semi-structured interviews were conducted with four primary care team members, including two RNs, one MA, and one FNP.

Results: The initial literature search yielded 4,544 articles. Application of the inquiry inclusion/exclusion criteria markedly reduced this number; 486 studies were published in the last 5 years, 70 studies included key search terms: suicide, primary care, adolescents, and nursing. Only four studies discussed the role of the RN. Interview participants reported MA’s initiate the suicide screening process with handoffs to providers. The RN role is limited. All participants (n = 4) expressed feeling mostly confident, comfortable, and competent in conducting suicide screening, yet they all expressed a desire to receive additional training on suicide screening, especially around how to talk to patients about suicide. Of note, the primary suicide screening instrument utilized is the PHQ-9. Finally, participants acknowledged a gap in the need and availability of behavioral health staff.

Conclusion: The interview sample size was small with only four interviews across two clinics; however, the results show a potential gap in practice where suicide is not being specifically screened in patients. There does not appear to be a universal suicide screening tool (or process) for adolescents in primary care. Further research should focus on validating a suicide-specific screening tool for adolescent populations in primary care or universally across multiple settings. While RNs may not have a prominent role in suicide screening and assessment in primary care, they currently fill this role in the ER and mental health units. RNs have the ability to assess patients and make well-reasoned clinical decisions. Based on the findings, it is entirely possible for a patient with suicide ideation to have contact with the receptionist, MA, provider, and behavioral health staff – completely circumventing the RN. More research needs to be done involving the role of the primary care RN in adolescent suicide screening.