Michigan Medicine researchers have developed the Computerized Adaptive Screen for Suicidal Youth (CASSY), a program that reliably predicts adolescent suicide risk within three months of an emergency room visit. The tool is designed for any teenager who is admitted to the emergency room for any length of time, regardless of if their visit was for a mental health emergency or not.
According to a paper published in JAMA Psychiatry, CASSY was able to predict a patient’s risk for a suicide attempt with around 88% accuracy when tested among 4,829 adolescents between the ages 12-17.
The pandemic has caused a surge of mental health issues, especially among students, due to the added stress of online school and feelings of isolation. The University of Michigan also excluded spring break from its academic calendar this year to deter students from traveling, granting students two “wellbeing days” — a move that faced criticism from students for not offering enough time for relaxation. Despite these numbers, there is not any current indication that the pandemic has caused an increase in suicide rates among teens.
Dr. Cheryl King, director of the Youth Depression and Suicide Prevention Program at the University and lead author of the paper, said CASSY is unique compared to other common screening tools since it is personalized toward the individual respondent. King said the questions on the digitized screen depend on the respondents’ previous responses.
According to King, having questions tailored to the respondents is essential, because teens who are suicidal display a range of risk signs that can vary widely among individuals. CASSY designs follow-up questions and determines how many questions to ask based on the respondents’ answers.
“Different teens get different combinations of questions,” King said. “There is no specific risk factor that is necessary or sufficient. We want to get different combinations and profiles of risk.”
King said unlike most suicide screening tools that give a yes or no response for suicide risk, CASSY combines the detected risk factors and determines a score for risk level. It also allows agencies using the screening tool to set a threshold level for risk detection.
According to King, there are two primary challenges when screening teens for suicide: accuracy, and having enough resources to provide help when the screen shows that a teen is high-risk. CASSY increases accuracy by asking about a range of topics like hopelessness, school connectedness, agitation and depression.
“We do not want to use a tool if it not a good predictor of suicide attempts or if it overpredicts,” King said. “The CASSY is doing very well as a tool and helps us meet the challenges more effectively than we have been able to in the past.”
University alum Timothy Mayer, who worked under King as a research assistant for the program, said the field of suicide prevention has been working towards developing artificial intelligence that identifies those at heightened risk on an individual level. The CASSY screening tool, Mayer said, helps researchers advance toward meeting that goal.
“We have built an understanding of demographics at risk, but we still haven’t been able to pick up on an individual level who is at an acute risk for attempting suicide,” Mayer said. “The (CASSY) has really great accuracy. It is not perfect, but it is a step towards future studies and future researchers building upon this.”
LSA junior Aashna Pradhan, who is a member of Dil Se, a student organization focused on combating mental health issues within the South Asian community, said CASSY seems like a great step toward identifying those at risk for attempting suicide. She said it is essential to recognize and treat mental health issues early on in order to decrease the rate of attempted suicides among youth.
“I do hope that researchers also find a way to identify mental health issues at a smaller scale as well for issues like depression and anxiety,” Pradhan said. “There are a lot of people who are struggling who may not be at risk of suicide but still really need help.”
King said she hopes CASSY raises greater awareness about the potential of universal screening in bringing down teen suicide levels.
“So many teens’ risk has gone unrecognized, and we actually can proactively identify them with screening and help those who screen positive link to services that can help them,” King said.
Daily Staff Reporter Navya Gupta can be reached at itznavya@umich.edu.