Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Clinical Trial
. 2012 Dec;166(12):1170-6.
doi: 10.1001/archpediatrics.2012.1276.

Ask Suicide-Screening Questions (ASQ): A Brief Instrument for the Pediatric Emergency Department

Free PMC article
Clinical Trial

Ask Suicide-Screening Questions (ASQ): A Brief Instrument for the Pediatric Emergency Department

Lisa M Horowitz et al. Arch Pediatr Adolesc Med. .
Free PMC article


Objective: To develop a brief screening instrument to assess the risk for suicide in pediatric emergency department patients.

Design: A prospective, cross-sectional instrument-development study evaluated 17 candidate screening questions assessing suicide risk in young patients. The Suicidal Ideation Questionnaire served as the criterion standard.

Setting: Three urban, pediatric emergency departments associated with tertiary care teaching hospitals.

Participants: A convenience sample of 524 patients aged 10 to 21 years who presented with either medical/surgical or psychiatric chief concerns to the emergency department between September 10, 2008, and January 5, 2011.

Main exposures: Participants answered 17 candidate questions followed by the Suicidal Ideation Questionnaire.

Main outcome measures: Sensitivity, specificity, predictive values, likelihood ratios, and area under the receiver operating characteristic curves of the best-fitting combinations of screening questions for detecting elevated risk for suicide.

Results: A total of 524 patients were screened (344 medical/surgical and 180 psychiatric). Fourteen of the medical/surgical patients (4%) and 84 of the psychiatric patients (47%) were at elevated suicide risk on the Suicidal Ideation Questionnaire. Of the 17 candidate questions, the best-fitting model comprised 4 questions assessing current thoughts of being better off dead, current wish to die, current suicidal ideation, and past suicide attempt. This model had a sensitivity of 96.9% (95% CI, 91.3-99.4), specificity of 87.6% (95% CI, 84.0-90.5), and negative predictive values of 99.7% (95% CI, 98.2-99.9) for medical/surgical patients and 96.9% (95% CI, 89.3-99.6) for psychiatric patients.

Conclusions: A 4-question screening instrument, the Ask Suicide-Screening Questions (ASQ), with high sensitivity and negative predictive value, can identify the risk for suicide in patients presenting to pediatric emergency departments.

Conflict of interest statement

Financial Disclosures

The other authors report no conflicts of interest.


Figure 1
Figure 1. Participant Flow
*A positive score on the Suicidal Ideation Questionnaire (SIQ) is defined as scoring above a cut-off of 31 on the SIQ-Jr or 41on the SIQ and/or a positive SIQ Critical Item response.

Comment in

Similar articles

See all similar articles

Cited by 33 articles

See all "Cited by" articles

Publication types