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

Objective: Children as young as preschool-aged 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 heighted 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 would address these concerns and give providers a much-needed tool for assessing STBs in young children. Method: A 4-item caregiver-report suicide-risk screener was developed and administered to caregivers of 80 children aged 4-7 years (Mage=6.06; SD=1.12) from diverse sociodemographic backgrounds. Caregivers and children independently completed an age-appropriate clinical diagnostic interview to assess STBs. Children with a history of STBs were oversampled. Results: Of the 80 suicide-risk screeners administered, 18 were positive (caregiver endorsed at least one item). Relative to caregiver diagnostic interviews, the caregiver-STB screener showed 85% sensitivity and 98.3% specificity for detecting STB risk. Additionally, relative to either caregiver or child diagnostic interviews, the screener showed 68% sensitivity and 98.2% specificity for detecting STB risk. Conclusion: The caregiver-STB screener for children under age 8 demonstrates favorable psychometric properties when compared to a reference standard. If further validated, this screener could offer clinicians a new brief tool to assess suicide risk and related mental health issues in young children. Its high specificity suggests that positive screens should be taken seriously as indicators of risk, warranting further follow-up.