CU researchers call for national ethics guidelines when student health surveys uncover suicide-risk

Public health agencies need ethical guidelines for deciding what to do when anonymous student health surveys discover a very high local rate of suicide-risk, according to CU researchers.

In a report published today in the highly influential American Journal of Bioethics, the researchers describe a student health survey team that discovered a Colorado school with extremely high rates of suicide risk, and a lack of ethical guidance on whether or how to intervene.

The case came from the Healthy Kids Colorado Survey, a voluntary statewide anonymous survey completed by students in participating schools across Colorado. In addition to reporting results for the entire state, the survey team compiles and returns results to each school.

“While compiling school results, the HKCS team noticed that one school’s suicide-risk rate was off the charts. They were alarmed but weren’t sure how to proceed, since the survey promises confidentiality of results,” said lead author Arnold H. Levinson, PhD, MJ, professor of Community and Behavioral Health at the Colorado School of Public Health.

In the end, the surveyors called the principal at the school, who said he would use the information to ask the district for extra resources to address suicide risks. The decision to call the principal was endorsed by a multidisciplinary team of CU researchers and ethicists from the CU Center for Bioethics and Humanities who examined the case.

But the authors of the new report note that the decision was not informed by ethical guidance.

“We searched for guidance from research ethics, medical ethics, public health ethics and education ethics,” Levinson said. “And we couldn’t find any directly applicable guidelines.”

“We urge national public health and education associations to produce guidance that clarifies the ethical and legal duties owed to randomly chosen schools and students that participate in anonymous surveys when surveillance activities identify high-risk clusters.”

Adolescent suicide is at epidemic levels in Colorado and the nation, noted a research team member, M. Franci Crepeau-Hobson, PhD, associate professor and director of clinical training, University of Colorado School of Education and Human Development.

“Schools should be conducting suicide-prevention programs, and administrators are responsible for ensuring their students’ health and safety,” she said. “Screening for suicide is the best approach, but at a minimum, school personnel should be trained to see signs of risk and appropriate ways to respond.”


The work was conducted by faculty at the Colorado School of Public Health and University of Colorado School of Medicine, located on the University of Colorado Anschutz Medical Campus, and the University of Colorado Denver. In addition to publishing the report, the American Journal of Bioethics has arranged a national webinar (9:00-10:15 a.m. MDT Wednesday, October 14) for the team to discuss the topic.

The Healthy Kids Colorado Survey is led by Ashley Brooks-Russell, assistant professor of Community and Behavioral Health in the Colorado School of Public Health, with funding from the Colorado Department of Public Health and Environment.

About the University of Colorado Anschutz Medical Campus

The University of Colorado Anschutz Medical Campus is a world-class medical destination at the forefront of transformative science, medicine, education, and patient care. The campus encompasses the University of Colorado health professional schools, more than 60 centers and institutes, and two nationally ranked independent hospitals that treat more than two million adult and pediatric patients each year. Innovative, interconnected and highly collaborative, together we deliver life-changing treatments, patient care, professional training, and conduct world-renowned research. For more information, visit

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