摘要：Objectives. We sought to determine the degree of overlap between students identified through school-based suicide screening and those thought to be at risk by school administrative and clinical professionals. Methods. Students from 7 high schools in the New York metropolitan area completed the Columbia Suicide Screen; 489 of the 1729 students screened had positive results. The clinical status of 641 students (73% of those who had screened positive and 23% of those who had screened negative) was assessed with modules from the Diagnostic Interview Schedule for Children. School professionals nominated by their principal and unaware of students' screening and diagnostic status were asked to indicate whether they were concerned about the emotional well-being of each participating student. Results. Approximately 34% of students with significant mental health problems were identified only through screening, 13.0% were identified only by school professionals, 34.9% were identified both through screening and by school professionals, and 18.3% were identified neither through screening nor by school professionals. The corresponding percentages among students without mental health problems were 9.1%, 24.0%, 5.5%, and 61.3%. Conclusions. School-based screening can identify suicidal and emotionally troubled students not recognized by school professionals. Voluntary universal screening is advocated as a practical approach to early identification of students at risk for suicide 1 – 3 based on the assumptions that adolescents do not reveal their suicidal thoughts or behaviors to others 4 – 6 and they are more likely to report stigmatizing information in a self-administered instrument than they are during a face-to-face evaluation. 7 , 8 It is not clear, however, the extent to which students identified as at risk during a school screening program overlap with those already of concern to school professionals. Many of the problems that bring a student to the attention of school staff—irritability, substance use, and school absences, for example—are associated with suicidal behavior. 9 – 12 The value of universal screening would be greatly reduced if school-based screening programs detected students already identified by school staff. Both screening and the evaluations of school professionals are imperfect methods of identifying students with mental health problems. Given the multiple demands on school administrative and clinical professionals, it would be impossible for these individuals to identify all students with mental health needs. On the other hand, screening for uncommon conditions often lacks specificity; that is, a high proportion of the students identified through screening will eventually be shown not to have the condition of interest. 13 We examined the overlap between students identified through systematic screening for suicide risk and those identified as at risk by school professionals. We expected that overlap would be greatest with respect to externalizing disorders such as substance abuse but that screening would identify students at elevated risk for suicide whose symptoms were less overt. In addition to assessing overlap, we examined the extent to which screening and school professionals' evaluations produced false positives and whether screening led to improved identification of students with mental health problems.
