JOURNAL ARTICLE

Ask Suicide-Screening Questions (ASQ): a brief instrument for the pediatric emergency department

Lisa M Horowitz, Jeffrey A Bridge, Stephen J Teach, Elizabeth Ballard, Jennifer Klima, Donald L Rosenstein, Elizabeth A Wharff, Katherine Ginnis, Elizabeth Cannon, Paramjit Joshi, Maryland Pao
Archives of Pediatrics & Adolescent Medicine 2012, 166 (12): 1170-6
23027429

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.

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