Suicidality among Youth in the Legal System: The Use of the Columbia-Suicide Severity Rating Scale Screener

Abstract

Youth involved in the legal system (YLS) report suicidal ideation and attempts at rates nearly three times higher than the general population. However, most suicidality research within YLS populations has focused on detained or incarcerated youth, and validated suicidality screeners are inconsistently used outside detention centers. We examined youth referred to probation in one Midwest county from January 2020-August 2023. We report 1) suicidality prevalence assessed via the Columbia-Suicide Severity Rating Scale (C-SSRS), 2) cross-tabulation between probation officers’ clinical decision making and C-SSRS risk categorization, and 3) prediction of C-SSRS receipt and severity among youth who underwent probation intake. Of 284 screens administered, with respect to the past month, 24.7% indicated desire to be dead, 21.5% suicidal ideation, 7.8% method, 10.2% suicidal intent, and 3.2% suicidal intent with a plan. Additionally, 2.1% indicated a suicide attempt within the past three months. Probation officers most commonly decided to only monitor youth after screening as high risk. Among 1,269 probation-referred cases, alleged felony charges and having more cases prior to the current case were associated with reduced odds of screening receipt. Female gender and not filing a court petition were associated with increased odds of screening higher risk. The results highlight the high suicidality prevalence, yet minimal service connection, among YLS. Research needs to investigate decision-making tools to aid post-screening intervention.