The pediatric community is facing a mental health (MH) crisis among US youth, which has been exacerbated by the COVID-19 pandemic. In 2021, the American Academy of Pediatrics (AAP) and other national organizations declared this crisis an emergency and the Surgeon General recently issued an advisory giving recommendation for supporting youth's mental health and calling for systemic change.1,2 Suicide was already the second leading cause of death in youth and young adults 10-24 years of age prior to COVID-19.3 More youth have presented to emergency departments (ED) for suicidal ideation and attempts during the COVID-19 pandemic4 and more have screened positive for suicide risk (suicidal thoughts and behaviors) using a standardized screener while in the ED during this time.4,5

Pediatric clinicians are well-positioned to identify and support youth at risk for suicide.6 A study involving eight Mental Health Research Network health systems in eight states found that among youth who died by suicide during 2000-2010, 77% visited a health care provider in the year prior to their suicide, and 38% within a month of their suicide and most visits were not with MH providers.7 These visits prior to death were missed opportunities to identify and support these youth and represent points where pediatric clinicians can intervene and help prevent deaths from suicide.

The AAP, American Foundation for Suicide Prevention, and National Institute of Mental Health co-hosted a Virtual Summit on Youth Suicide Prevention in 2021 and subsequently developed a Blueprint for Youth Suicide Prevention.6 The Blueprint and the 2022 Recommendations for Preventive Pediatric Care include recommendations for universal, annual screening of youth 12 years and older using validated tools to identify suicide risk. Screening for youth 8-11 years is recommended when clinically indicated. Screening for suicide risk has been shown to be feasible and effective in health care settings,8, 9, 10 including pediatric primary care.11 More needs to be learned about pediatricians’ experiences, attitudes, and practices related to assessing suicide risk. Existing studies are either dated,12 limited to trainees and recent graduates,13,14 or are not multi-centered studies which limits their generalizability.10,11

The purpose of the current study was to perform a national study to describe pediatricians’ experiences caring for youth with suicidal thoughts and behaviors, attitudes about addressing suicide and attempts, and practices identifying and managing suicidal ideation (SI) in advance of the 2022 release of updated screening recommendations. We also sought to examine associations between reported experiences with patients with suicidal thoughts, behaviors, or deaths and pediatricians’ current screening practices. Prior studies indicated that providers who think MH problems are prevalent in their patients are more likely to believe they are responsible for managing them, and more frequently treat MH problems. Therefore, we hypothesized that pediatricians are more likely to formally screen for suicidal ideation if they previously had patients who attempted or died by suicide.