# Retrospective Evaluation of the Implementation of Universal Suicide Risk Screening for Youth in the Perioperative and Procedural Areas of a Health System

## TL;DR

This study shows that universal suicide risk screening for youth can be successfully implemented in surgical and procedural settings, identifying a notable number of at-risk patients.

## Contribution

The study provides empirical evidence for implementing suicide risk screening in underutilized perioperative and procedural areas for youth.

## Key findings

- About 89% of youth encounters had at least one suicide risk screening question completed.
- Positive screens occurred in 3.6% of encounters, with 0.1% indicating imminent risk.
- Females had higher odds of positive screens compared to males.

## Abstract

Suicide is a leading cause of death among US youth. Universal suicide risk screening can identify youth with unmet mental health needs, enabling interventions and linkage to services, yet screening is not widely implemented in perioperative and procedural settings.

We retrospectively assessed implementation of universal suicide risk screening for youth in perioperative and procedural areas of a pediatric health system by examining screening completion rates, positivity rates, and demographic and clinical factors associated with screening.

We conducted a retrospective cross‐sectional study of universal suicide risk screening among youth 10–21 years of age in perioperative and procedural areas of an academic children's hospital and two affiliated ambulatory surgical centers, using electronic health record data from August 2022 to February 2025. We described rates of screening completion using Ask Suicide‐Screening Questions (ASQ) and screening positivity rates. We used multivariable logistic regression to examine factors associated with (1) screening completion and (2) positive screens.

Among 15 204 perioperative and procedural encounters (median age 14 [interquartile range 12, 16], 45% female), 13 566 (89.2%) had at least one ASQ item completed. Of these encounters, 494 (3.6%) had positive screens and 7 (0.1%) had screens indicating imminent risk. Adjusted odds of screening completion were lower among youth aged 10–12 than 13–15 years (adjusted odds ratio [aOR] 0.69, 95% CI 0.61–0.78) and those who preferred a language other than English or Spanish versus those who preferred English (aOR 0.55, 95% CI 0.41–0.75). Adjusted odds of positive screens were higher among females than males (aOR 2.49, 95% CI 2.06–3.03) and lower in ambulatory surgical centers than the children's hospital (aOR 0.26, 95% CI 0.14–0.42).

Universal suicide risk screening can be implemented in perioperative and procedural areas, with positive screens in about 1 in 28 encounters. These settings represent an underutilized opportunity to identify at‐risk youth.