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

Arch Pediatr Adolesc Med. 2012 Dec;166(12):1170-6. doi: 10.1001/archpediatrics.2012.1276.

Abstract

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.

Publication types

  • Clinical Trial
  • Research Support, N.I.H., Extramural
  • Research Support, N.I.H., Intramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Child
  • Cross-Sectional Studies
  • Emergency Service, Hospital*
  • Female
  • Humans
  • Logistic Models
  • Male
  • Mass Screening*
  • Pediatrics
  • Prospective Studies
  • Risk Assessment
  • Sensitivity and Specificity
  • Suicidal Ideation
  • Suicide*
  • Suicide, Attempted
  • Surveys and Questionnaires*
  • Young Adult