O2074: Suicidal Ideation in Pediatric Orthopedic Patients

Background: Suicide is the second leading cause of death among American children aged 10 to 18 years, and those with physical health conditions have a 20% increase in suicidal ideation relative to their healthy peers. Despite this, suicidality in children with musculoskeletal problems is largely unstudied. The purpose of this study is therefore to determine the prevalence of suicidal ideation in pediatric orthopaedic patients and identify risk factors for endorsement of suicidality.

Methods: A retrospective review of all patients aged 10 years and older presenting for outpatient orthopaedic evaluation to a single pediatric institution over a 2-year period was conducted. Demographic information, primary orthopaedic diagnosis, treatment history, pain symptomatology, and responses on the Ask Suicide Screening Questionnaire were compared between patients who endorsed suicidality and a matched cohort of patients without suicidal ideation.

Results: Of 6710 individual patient encounters, 163 children (2.4%) endorsed suicidal ideation and 7/163 (4.3%) were experiencing active and imminent suicidal thoughts. Patients endorsing suicidality were predominantly female (73%), Caucasian (72%), and had a mean age of 14.6 years. When compared to the matched cohort, children endorsing suicidality were significantly more likely to present with a chief complaint of pain or emotional concerns (44.8% vs. 22.1%, p=0.0005) and were ultimately more likely to receive a non-structural, non-mechanical pain diagnosis (17.2% vs. 5.5%, p=0.0009). No other differences in ultimate diagnosis were identified between suicidal and non-suicidal patients with regard to general anatomic location (spine, hip, upper extremity, lower extremity) or specific diagnoses within these regions. Though suicidal patients with pain were more likely than the matched cohort to characterize their pain as persistent or chronic (75.3% vs. 58.3%, p=0.08) this difference trended towards, but did not reach, statistical significance.

Conclusion: Suicidal ideation is not uncommon among adolescent pediatric orthopaedic patients presenting for outpatient care. White females with chronic pain complaints appear be at particularly high risk. This is the first study to assess suicidal ideation in a large, outpatient, pediatric orthopaedic population. This data suggests that mental health screening and the provision of integrated clinical care with psychologists and other behavioral health specialists is important to provide comprehensive care to adolescent orthopaedic patients.