Diagnostics of Suicidal Risk in Adolescents: Systematic Review of Systematic Reviews



Study relevance. Revealing groups of people at high risk of suicide is important for suicide prevention, especially among adolescents, and the practical way of achieving it is screening adolescents for suicide risk. A major obstacle to the development of screening protocols and other preventive procedures is lack of data or conflicting data on measures that can be used in adolescent samples. Objective. The current systematic review of systematic reviews was carried out to discover measures of suicide risk with a good predictive validity on adolescent samples. Recommendations for screening implementation were also narratively reviewed. Method. Literature search was carried out in PubMed, Cochrane Database of Systematic Reviews, EBSCO Academic Search Premier, EBSCO Health Source: Nursing and Academic Edition, and Elibrary. 10 papers that satisfied all inclusion criteria (systematic reviews of measures assessing the risk of suicide in children and adolescents) were included in the study. Results. The reviews included in the study were of satisfactory quality. Predictive validity was reported for 18 measures, 16 of them were self-report, and 2 were versions of the Implicit Associative Test. Computerized tests showed relatively low predictive validity coefficients, while self-report measures (including screening questions) had higher predictive validity. Conclusion. More studies of predictive validity of the suicide screening measures on adolescent samples are needed. The decision to use a measure in the screening protocol should be also based on practical considerations and resources available to medical workers on cite.

General Information

Keywords: systematic review, suicidal behavior, measures, risk assessment, screening, predictive validity

Journal rubric: Research Reviews

Article type: review article

DOI: https://doi.org/10.17759/cpp.2023310202

Received: 03.05.2023


For citation: Razvaliaeva A.Y., Polskaya N.A., Basova A.Ya. Diagnostics of Suicidal Risk in Adolescents: Systematic Review of Systematic Reviews. Konsul'tativnaya psikhologiya i psikhoterapiya = Counseling Psychology and Psychotherapy, 2023. Vol. 31, no. 2, pp. 33–67. DOI: 10.17759/cpp.2023310202. (In Russ., аbstr. in Engl.)


  1. Aromataris E., Fernandez R., Godfrey C., et al. Summarizing systematic reviews: methodological development, conduct and reporting of an Umbrella review approach. International Journal of Evidence-Based Healthcare, 2015. Vol. 13 (3), pp. 132–140. DOI: 10.1097/XEB.0000000000000055
  2. Bagge C., Osman A. The Suicide Probability Scale: Norms and factor structure. Psychological Reports, 1998. Vol. 83, pp. 637–638. DOI: 10.2466/pr0.1998.83.2.637
  3. Beck A.T., Steer R.A. Beck hopelessness scale manual. San Antonio, TX: Harcourt Brace, 1988. 29 p.
  4. Bernert R.A., Hom M.A., Roberts L.W. A review of multidisciplinary clinical practice guidelines in suicide prevention: toward an emerging standard in suicide risk assessment and management, training and practice. Academic Psychiatry, 2014. Vol. 38, pp. 585–592. DOI: 10.1007/s40596-014-0180-1
  5. Brent D.A., Grupp-Phelan J., O’Shea B.A., et al. A comparison of self-reported risk and protective factors and the death implicit association test in the prediction of future suicide attempts in adolescent emergency department patients. Psychological Medicine, 2021. Vol. 53 (1), pp. 123–131. DOI: 10.1017/S0033291721001215
  6. Centers for Disease Control and Prevention. Facts About Suicide. April 6, 2023 [Elektronnyi resurs]. Available at: https://www.cdc.gov/suicide/facts/index.html​​​​​​​(Accessed 01.05.2023).
  7. Cervantes P.E., Seag D.E., Baroni A., et al. Universal suicide risk screening for youths in the emergency department: a systematic review. Psychiatric Services, 2022. Vol. 73 (1), pp. 53–63. DOI: 10.1176/appi.ps.202000881
  8. Cull J.G., Gill W.S. Manual for the Suicide Probability Scale. Los Angeles, CA: Western Psychological Services, 1992. 67 p.
  9. Czyz E.K., Horwitz A.G., King C.A. Self-rated expectations of suicidal behavior predict future suicide attempts among adolescent and young adult psychiatric emergency patients. Depression and Anxiety, 2016. Vol. 33 (6), pp. 512–519. DOI: 10.1002/da.22514
  10. Erford B.T., Jackson J., Bardhoshi G., et al. Selecting suicide ideation assessment instruments: A meta-analytic review. Measurement and Evaluation in Counseling and Development, 2018. Vol. 51 (1), pp. 42–59. DOI: 10.1080/07481756.2017.1358062
  11. Faurа-Garcia J., Orue I., Calvete E. Clinical assessment of non‐suicidal self‐injury: A systematic review of instruments. Clinical Psychology & Psychotherapy, 2021. Vol. 28 (4), pp. 739–765. DOI: 10.1002/cpp.2537
  12. Gaynes B.N., West S.L., Ford C., et al. Screening for Suicide Risk: A Systematic Evidence Review for the U.S. Preventive Services Task Force. Rockville: Agency for Healthcare Research and Quality (US), 2004. 32 p.
  13. Harris I.M., Beese S., Moore D. Predicting future self-harm or suicide in adolescents: a systematic review of risk assessment scales/tools. BMJ Open, 2019. Vol. 9, p. e029311. DOI: 10.1136/bmjopen-2019-029311
  14. Horowitz L.M., Bridge J.A., Teach S.J., et al. Ask Suicide-Screening Questions (ASQ): a brief instrument for the pediatric emergency department. Archives of Pediatrics and Adolescent Medicine, 2012. Vol. 166, pp. 1170–1176. DOI: 10.1001/archpediatrics.2012.1276
  15. Horowitz L.M., Wang P.S., Gerald P., et al. Detecting suicide risk in a pediatric ED: Development of a brief screening tool. Pediatrics, 2001. Vol. 107, pp. 1133–1137. DOI: 10.1542/peds.107.5.1133
  16. King C.A., Berona J., Czyz E., et al. Identifying adolescents at highly elevated risk for suicidal behavior in the emergency department. Journal of Child and Adolescent Psychopharmacology, 2015. Vol. 25 (2), pp. 100–108. DOI: 10.1089/cap.2014.0049
  17. King C.A., Brent D., Grupp-Phelan J., et al. Prospective development and validation of the computerized adaptive screen for suicidal youth. JAMA Psychiatry, 2021. Vol. 78, pp. 540–549. DOI: 10.1001/jamapsychiatry.2020.4576
  18. Munn Z., Stern C., Aromataris E. et al. What kind of systematic review should I conduct? A proposed typology and guidance for systematic reviewers in the medical and health sciences. BMC Medical Research Methodology, 2018. Vol. 18 (5), p. 5. DOI: 10.1186/s12874-017-0468-4
  19. Newton A.S., Soleimani A., Kirkland S.W., et al. A systematic review of instruments to identify mental health and substance use problems among children in the emergency department. Academic Emergency Medicine, 2017. Vol. 24 (5), pp. 552–568. DOI: 10.1111/acem.13162
  20. Nock M.K., Banaji M.R. Assessment of self-injurious thoughts using a behavioral test. American Journal of Psychiatry, 2007. Vol. 164, pp. 820–823. DOI: 10.1176/ajp.2007.164.5.820
  21. Nock M.K., Holmberg E.B., Photos V.I., et al. The Self-Injurious Thoughts and Behaviors Interview: development, reliability, and validity in an adolescent sample. Psychological Assessment, 2007. Vol. 19 (3), pp. 309–317. DOI: 10.1037/1040-3590.19.3.309
  22. Nock M.K., Park J.M., Finn C.T., et al. Measuring the suicidal mind: Implicit cognition predicts suicidal behavior. Psychological Science, 2010. Vol. 21 (4), pp. 511–517. DOI: 10.1177/0956797610364762
  23. O'Connor E., Gaynes B.N., Burda B.U., et al. Screening for and treatment of suicide risk relevant to primary care: a systematic review for the US Preventive Services Task Force. Annals of Internal Medicine, 2013. Vol. 158 (10), pp. 741–754. DOI: 10.7326/0003-4819-158-10-201305210-00642
  24. Ougrin D., Boege I. Brief report: the self harm questionnaire: a new tool designed to improve identification of self harm in adolescents. Journal of Adolescence, 2013. Vol. 36 (1), pp. 221–225. DOI: 10.1016/j.adolescence.2012.09.006
  25. Page M.J., McKenzie J.E., Bossuyt P.M., et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ, 2021. Vol. 372. DOI: 10.1136/bmj.n71
  26. Posner K., Brown G.K., Stanley B., et al. The Columbia-Suicide Severity Rating Scale: initial validity and internal consistency findings from three multisite studies with adolescents and adults. American Journal of Psychiatry, 2011. Vol. 168, pp. 1266–1277. DOI: 10.1176/appi.ajp.2011.10111704
  27. Poznanski E.O., Mokros H.B. Children’s depression rating scale—revised (CDRS-R). Los Angeles, CA: Western Psychological Services, 1996. 78 p.
  28. Quinlivan L., Cooper J., Davies L., et al. Which are the most useful scales for predicting repeat self-harm? A systematic review evaluating risk scales using measures of diagnostic accuracy. BMJ Open, 2016. Vol. 6, p. e009297. DOI: 10.1136/bmjopen-2015-009297
  29. Reynolds W.M. Reynolds Suicidal Ideation Questionnaire: Professional manual. Odessa, FL: Psychological Assessment Resources, 1988. 47 p.
  30. Rowe S.L., French R.S., Henderson C., et al. Help-seeking behaviour and adolescent self-harm: a systematic review. Australian & New Zealand Journal of Psychiatry, 2014. Vol. 48 (12), pp. 1083–1095. DOI: 10.1177/0004867414555718
  31. Runeson B., Odeberg J., Pettersson A., et al. Instruments for the assessment of suicide risk: A systematic review evaluating the certainty of the evidence. PLoS ONE, 2017. Vol. 12 (7), p. e0180292. DOI: 10.1371/journal.pone.0180292
  32. Rutman M., Shenassa E., Becker B. Brief screening for adolescent depressive symptoms in the emergency department. Academic Emergency Medicine, 2008. Vol. 15 (1), pp. 17–22. DOI: 10.1111/j.1553-2712.2007.00002.x
  33. Scudder A., Rosin R., Nelson B.B., et al. Suicide screening tools for pediatric emergency department patients: a systematic review. Frontiers in Psychiatry, 2022. Vol. 13, p. 916731. DOI: 10.3389/fpsyt.2022.916731
  34. Shaffer D., Scott M., Wilcox H., et al. The Columbia Suicide Screen: validity and reliability of a screen for youth suicide and depression. Journal of the American Academy of Child and Adolescent Psychiatry, 2004. Vol. 43 (1), pp. 71–79. DOI: 10.1097/00004583-200401000-00016
  35. Smith V., Devane D., Begley C.M., et al. Methodology in conducting a systematic review of systematic reviews of healthcare interventions. BMC Medical Research Methodology, 2011. Vol. 11, p. 15. DOI: 10.1186/1471-2288-11-15
  36. Thompson E.A., Eggert L.L. Using the suicide risk screen to identify suicidal adolescents among potential high school dropouts. Journal of the American Academy of Child and Adolescent Psychiatry, 1999. Vol. 38, pp. 1506–1514. DOI: 10.1097/00004583-199912000-00011
  37. Viswanathan M., Wallace I.F., Cook Middleton J., et al. Screening for Depression and Suicide Risk in Children and Adolescents Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA, 2022. Vol. 328 (15), pp. 1543–1556. DOI: 10.1001/jama.2022.16310
  38. Woodford R., Spittal M.J., Milner A., et al. Accuracy of Clinician Predictions of Future Self-Harm: A Systematic Review and Meta-Analysis of Predictive Studies. Suicide and Life-Threatening Behavior, 2019. Vol. 49 (1), pp. 23–40. DOI: 10.1111/sltb.1239

Information About the Authors

Anna Y. Razvaliaeva, PhD in Psychology, Researcher, Laboratory of Cognitive Processes and Mathematical Psychology, Institute of Psychology of the Russian Academy of Sciences, Moscow, Russia, ORCID: https://orcid.org/0000-0002-2046-3411, e-mail: annraz@rambler.ru

Natalia A. Polskaya, Doctor of Psychology, Associate Professor, Professor of the Clinical Psychology and Psychotherapy Department, Faculty of Counseling and Clinical Psychology, Moscow State University of Psychology & Education, Leading Researcher, Scientific and Practical Center for Mental Health of Children and Adolescents named after G.E. Sukhareva of the Moscow Department of Public Health, Moscow, Russia, ORCID: https://orcid.org/0000-0002-7305-5577, e-mail: polskayana@yandex.ru

Anna Y. Basova, PhD in Medicine, Deputy Director for Research, Scientific and Practical Center for Mental Health of Children and Adolescents named after G.E. Sukhareva, Associate Professor, Department of Psychiatry and Medical Psychology, Pirogov Russian National Research Medical University, Moscow, Russia, ORCID: https://orcid.org/0000-0002-5001-8554, e-mail: dr.anna.basova@gmail.com



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