Suicide Prevention in Luxembourg: Using the HBSC Symptom Checklist as an Alternative Tool for Screening

Introduction: Suicide is one of the leading causes of death of young people and as such, screening for suicidal ideation is a major public health concern. However, there is fear that exposure to suicide-related content would encourage suicide attempt. This false idea is a great barrier to effectively screen. Hence, the need for tools without suicide content.
Purpose: The goal of this study is to present a short tool that could be helpful for suicide screening and prevention.
Materials and Methods: This study is based on the 2014 HBSC Luxembourg survey. A total of 5595 students aged from 12 to 18 years old in secondary school responded to a questionnaire translated to both French and German. Among others, it included the HBSC Symptom Checklist, a scale developed to measure eight health complaints (headache, abdominal pain, backache, feeling low, irritability, feeling nervous, sleeping difficulties and dizziness), as well as 4 questions asked in a logical sequence concerning sadness, suicide ideation, suicide planning and suicide attempt.
Results: Multivariate Logistic Regression analyses with 24 potential indicators showed the number of health complaints as the most predictive indicator for suicide attempt (OR=1.248; C.I.: 1.175-1.325). Following, a significant ROC curve (area under the curve of 0.76; sensitivity=0.68 and specificity=0.73) and Youden Index (0.41) indicates the optimum cut-off at three complaints, with a predictive value of 17%. An alternative cut off point at four (sensitivity=0.57 and specificity=0.82; Youden Index of 0.39) has a predictive value of 21%.
Conclusion: The HBSC Symptom Checklist seems to be a good predictor as each additional health complaint increases the risk of suicide attempt by 25%. In addition, it could be an alternative to traditional suicide screening measures, as its sensitivity, specificity and predictive values are similar to measures more commonly used, such as the Columbia Suicide Screen or the Beck Depression Inventory. Further work should be invested to validate the HBSC Symptom Checklist as a screening tool for suicide prevention.