(PS7-74) Utility of Assessing Ruminative Brooding in a School-Based Mental Health Screening Tool

School-based screening can identify students at risk for suicide and mental health concerns that go unnoticed by school staff (Scott et al., 2009). The Samaritan Wellness Screen Program was created to identify middle and high school students at risk for suicide and refer them to services (Hilt et al., 2018). The screening tool assesses general psychopathology as well as suicidal thoughts and behaviors. During the 2022-2023 school year, we added the ruminative brooding subscale (Treynor et al., 2003) to the Samaritan Wellness Screen given that rumination is a robust transdiagnostic risk factor (Watkins & Roberts, 2020). We examined whether adding the brooding subscale to the screening tool improved its psychometrics and more accurately identified students at risk. We hypothesized that the addition of the brooding subscale would increase the sensitivity of the Samaritan Wellness Screen, identifying students who would have otherwise been missed.  

To assess this hypothesis, we compared the accuracy of the Samaritan Wellness Screen without the brooding subscale to the accuracy with the brooding subscale during the 2022-2023 school year in all schools using the screening tool in Northeastern Wisconsin. We then replicated this analysis with students from the following school year, 2023-2024. Parents provided consent and students assented prior to participation. In the first sample (n = 5,554), the sensitivity of the screening tool without the brooding subscale (SN = 90.8%) was increased with the addition of the brooding subscale (SN = 99.18%), X2 = 3.91. p = .048. There was no significant effect of adding the brooding subscale on the specificity (SP) of the screening tool (without the brooding subscale, SP = 92.5%;  with the brooding subscale, SP = 90.67%). Similarly, there was no difference in the positive predictive value and negative predictive value with and without the brooding subscale. In the replication sample (n = 4,692), similar psychometrics were found, but there were no significant differences between the tool with and without the brooding subscale on any of the metrics. 

The results of this study suggest there is utility in assessing ruminative brooding in school-based mental health screening, as it increased the ability of an already robust screening tool to identify students who were at risk for suicide and/or in need of mental health treatment without sacrificing the tool’s specificity. Although the sensitivity for the Samaritan Wellness Screening tool was already very high, the addition of the brooding scale improved the sensitivity in one of the samples. Furthermore, across both samples, the brooding subscale accurately identified 295 students who would have otherwise been missed and not referred onto mental health resources. The implications of this study help to further our understanding of school-based mental health screening and the role of screening for ruminative brooding in a school setting. One limitation of the study is that we relied on student self-report to determine to false negatives in some cases. Thus, additional research on the brooding ruminative subscale will require stronger clinical assessments to accurately determine false positive rates.