5 - (SYM 121) Suicidality Among Youth Served by Children's Advocacy Centers

Background: Children’s Advocacy Centers (CACs) provide coordinated interagency responses to sexual abuse and other severe maltreatment. There are >950 CACs in the United States, covering 75% of counties and serving hundreds of thousands of children annually. Youth served by CACs are at high risk of suicide. The most common reason for youth to be served by CACs is allegations of sexual abuse (65% of youth), and sexual abuse is associated with more than three times the risk of suicide attempts.

Methods: Youth (5-18 years old) served by CACs in a single state (N = 2337) were screened for suicidality as part of a structured mental health screening/referral protocol. We examined descriptive statistics for suicidality and used chi-square tests and multilevel regression analyses to test associations between youth characteristics, traumatic stress symptoms, and suicidality.

Results: Thoughts about suicide/self-harm were endorsed by 39.1% of youth. Based on follow-up questions using the Columbia Suicide Severity Rating Scale, 246 youth were classified as high risk for suicide (10.5% of the full sample; 26.9% of those reporting thoughts about suicide/self-harm). Children seen in urban CACs were more likely to report any ideation than those seen in rural CACs (42.4% vs. 34.8%); the same pattern was found for children at high risk for suicide (11.6% vs. 9.0%). In multilevel analyses accounting for nesting within CACs, children who identified as female or transgender male were more likely to report suicidal ideation than those who identified as male, and older children were more likely to report suicidal ideation than younger children. Gender and age were also significantly associated with a higher likelihood of being identified as at high risk for suicide. Race/ethnicity and concern for sexual abuse were not significantly associated with the likelihood of any ideation or identification as high risk. Youth with high traumatic stress symptoms were more likely to report thoughts about suicide/self-harm and be identified as at high risk for suicide.

Conclusions: Screening for suicidality in CACs is feasible and identifies many youth at risk. However, there has been little concerted effort by CACs to address suicide, particularly in rural areas where youth suicide rates are high and rising rapidly. Implementation of universal screening and effective brief interventions in CACs may reduce youth suicide risk. We will discuss community partners’ feedback and ideas on future directions for suicide prevention in CACs.