Suicidal Ideation, Care Gaps, and Youth-Reported Risk and Protective Factors from a Tablet-Delivered Screener In School Settings

Background and Purpose. Suicidal ideation (SI) among youth is a critical public health concern, yet many young people experiencing SI remain unidentified and unconnected to mental health care. School-based mental health screening offers an opportunity to identify risk earlier and expand access to support, particularly in under-resourced communities. However, traditional screening approaches may fail to capture the contextual and lived experiences that shape risk and resilience. Brief, youth-centered digital screening tools that integrate both structured indicators and open-ended responses may enhance identification of SI and provide clinically actionable information. Among youth completing a tablet-delivered screener, this study: (1) examined rates of SI endorsement and current mental health care engagement, (2) compared SI-endorsing youth to peers without SI on mental health indicators, and (3) characterized modifiable risk and protective factors captured by youths’ free-response narratives.

Methods. Seventy-five youth (ages 8–18 years; M=11.9) at six Bronx, NY charter schools completed a tablet-delivered screener, TweenScreen, administered by school staff. Suicidal ideation (SI) included endorsement of either of two items ("ever felt so hopeless that you wanted to die"; "ever had thoughts or plans of taking your own life”). The screener also assessed engagement in mental health treatment, happiness and sadness, intrusive or distracting thoughts, and peer victimization. We compared youth reporting SI to those not reporting SI on these characteristics using Cohen’s d and odds ratios. Free-response questions also asked youth to describe their distracting or intrusive thoughts, their strengths, and their sources of energy. Free responses were categorized by a natural language processing algorithm with human oversight, surfacing risk and protective factors in youths’ own words.

Results. Eighteen of 75 youth (24%) endorsed SI. Among them, 67% reported no current mental health care. Notably, the screener also captured an instance where a participant initially endorsed suicidal ideation and then retracted it. SI-endorsing youth reported lower happiness (Cohen's d=−0.73, p=.008), were more likely to endorse intrusive or distracting thoughts (OR=6.7, p=.011) and peer victimization (OR=3.9, p=.031), and had higher sadness (Cohen’s d=+0.48, p=.047). Among SI-endorsing youth, free-response narratives surfaced both risk factors (anxiety and worry, grief and loss, family and home concerns, self-worth and negative self-talk, and intrusive thoughts) and protective factors (sports and athletics, arts and creativity, social and character strengths, people and relationships, and personal resilience). Exemplary free responses characterizing specific treatment targets and protective factors among youth with SI will be presented.

Conclusions and Implications. A brief tablet-delivered screener administered by program staff identified a substantial number of students endorsing SI, two-thirds of whom were not currently connected to mental health care. The screener identified behavioral health factors associated with SI, as well as personal risk and protective factors identified by youth themselves that can directly inform intervention planning. The screener also captured disclosure-retraction behavior that is invisible to traditional screening. Future research with larger samples may explore whether screening data from such tools can support data-driven SI risk stratification, as well as targeted delivery of preventive interventions.