Researchers at Children’s Hospital of Philadelphia’s (CHOP) Center for Violence Prevention (CVP) found that some adolescents who come to the emergency department (ED) for physical health concerns – not an overt mental health crisis – may still be at immediate risk for self-harm. Their findings were recently published in the journal of Academic Emergency Medicine.
Suicide is the second leading cause of death among adolescents. After the pandemic, CHOP and experts nationwide reported a sharp rise in adolescent psychiatric emergencies, including more suicidal thoughts and attempts. In this study, higher odds of recent suicide risk among patients with a physical health complaint were also associated with being younger (particularly ages 12–13), having Medicaid insurance, identifying as LGBTQ+ or female, and identifying as Black, multiracial, American Indian, Alaska Native, Native Hawaiian or Other Pacific Islander.
In an 11-year analysis of universal suicide screening data for patients ages 12–21 from a large urban pediatric ED, investigators examined how often recent suicidal thoughts or behaviors were identified during visits for physical health complaints, and which presenting symptoms and patient factors were most strongly associated with elevated risk.
Using a brief, validated digital questionnaire routinely offered in this ED, the study analyzed 65,705 screened visits from 2013–2024. Most screens occurred during visits for physical complaints (49,621 visits; 75.5%), and most of these encounters ended in discharge.
Researchers found that screening identified past-week suicidal thoughts, plans, or attempts in 1,179 medical visits (2.4%). Nearly two-thirds of adolescents who screened positive during medical visits were discharged, emphasizing why identification in the ED matters: it can initiate safety planning, counseling and follow-up that might otherwise never occur.
The study also identified medical presentations where hidden suicide risk was substantially more likely. Compared with fever, odds of past-week suicidal thoughts or behaviors were markedly higher among visits for poisoning or ingestion, sexually transmitted infection concerns, child abuse or sexual assault, and injury or trauma.
The authors emphasized that elevated risk was not limited to clearly high-risk scenarios (such as ingestion or assault). It also appeared alongside common, nonspecific complaints – such as urinary symptoms, feeding/eating issues, abdominal pain, and headache.
“Perhaps the most important takeaway is that as parents, caregivers, and clinicians, we need to pay attention to physical symptoms and not wait for a child to say they’re in crisis,” said Polina Krass, MD, the study’s lead author, a Pediatric Emergency Medicine attending physician and a CVP Research Scholar. “If we only screen when the visit is obviously psychiatric, we’re going to miss many kids who are struggling, including those who come in with everyday physical symptoms. Early identification of youth in mental health crisis is essential to providing connection to timely, life-saving interventions.”
The study’s findings support making suicide screening a routine part of adolescent emergency care, not something reserved for visits labeled “psychiatric.” The aim is straightforward: identify risk earlier, connect families to resources, and create a safer plan before a teen leaves the ED – even when the visit appears unrelated to mental health.
Krass et al. “Characteristics of Adolescents with Elevated Suicide Risk Presenting to the ED With Physical Health Complaints.” Academic Emergency Medicine. Online April 28, 2026. DOI: 10.1111/acem.70307.
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Researchers at Children’s Hospital of Philadelphia’s (CHOP) Center for Violence Prevention (CVP) found that some adolescents who come to the emergency department (ED) for physical health concerns – not an overt mental health crisis – may still be at immediate risk for self-harm. Their findings were recently published in the journal of Academic Emergency Medicine.
Suicide is the second leading cause of death among adolescents. After the pandemic, CHOP and experts nationwide reported a sharp rise in adolescent psychiatric emergencies, including more suicidal thoughts and attempts. In this study, higher odds of recent suicide risk among patients with a physical health complaint were also associated with being younger (particularly ages 12–13), having Medicaid insurance, identifying as LGBTQ+ or female, and identifying as Black, multiracial, American Indian, Alaska Native, Native Hawaiian or Other Pacific Islander.
In an 11-year analysis of universal suicide screening data for patients ages 12–21 from a large urban pediatric ED, investigators examined how often recent suicidal thoughts or behaviors were identified during visits for physical health complaints, and which presenting symptoms and patient factors were most strongly associated with elevated risk.
Using a brief, validated digital questionnaire routinely offered in this ED, the study analyzed 65,705 screened visits from 2013–2024. Most screens occurred during visits for physical complaints (49,621 visits; 75.5%), and most of these encounters ended in discharge.
Researchers found that screening identified past-week suicidal thoughts, plans, or attempts in 1,179 medical visits (2.4%). Nearly two-thirds of adolescents who screened positive during medical visits were discharged, emphasizing why identification in the ED matters: it can initiate safety planning, counseling and follow-up that might otherwise never occur.
The study also identified medical presentations where hidden suicide risk was substantially more likely. Compared with fever, odds of past-week suicidal thoughts or behaviors were markedly higher among visits for poisoning or ingestion, sexually transmitted infection concerns, child abuse or sexual assault, and injury or trauma.
The authors emphasized that elevated risk was not limited to clearly high-risk scenarios (such as ingestion or assault). It also appeared alongside common, nonspecific complaints – such as urinary symptoms, feeding/eating issues, abdominal pain, and headache.
“Perhaps the most important takeaway is that as parents, caregivers, and clinicians, we need to pay attention to physical symptoms and not wait for a child to say they’re in crisis,” said Polina Krass, MD, the study’s lead author, a Pediatric Emergency Medicine attending physician and a CVP Research Scholar. “If we only screen when the visit is obviously psychiatric, we’re going to miss many kids who are struggling, including those who come in with everyday physical symptoms. Early identification of youth in mental health crisis is essential to providing connection to timely, life-saving interventions.”
The study’s findings support making suicide screening a routine part of adolescent emergency care, not something reserved for visits labeled “psychiatric.” The aim is straightforward: identify risk earlier, connect families to resources, and create a safer plan before a teen leaves the ED – even when the visit appears unrelated to mental health.
Krass et al. “Characteristics of Adolescents with Elevated Suicide Risk Presenting to the ED With Physical Health Complaints.” Academic Emergency Medicine. Online April 28, 2026. DOI: 10.1111/acem.70307.
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