Ask Suicide-Screening Questions (ASQ)

Horowitz, Lisa M.; Bridge, Jeffrey A.; Teach, Stephen J.; Ballard, Elizabeth D.; Klima, Jennifer; Rosenstein, Donald L.; Wharff, Elizabeth A.; Ginnis, Katherine; Cannon, Elizabeth; Joshi, Paramjit T.; Pao, Maryland

doi:10.1001/archpediatrics.2012.1276

Cited by 413 publications

(153 citation statements)

References 24 publications

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“…The final 4 items selected assessed current and passive thoughts of suicide and past suicidal behavior (Table 1). 12 This suggests that asking pediatric ED patients questions using validated screening instruments that directly probe for suicidal thoughts and behaviors may be the best strategy to identify youth at risk for suicide. 26,27 Although the bullying item did not prove specific enough to be a valid screening question for suicide risk in a general ED population, this current analysis indicates that, among pediatric ED patients, recent bullying victimization may be an important risk factor for suicide.…”

Section: Discussionmentioning

confidence: 99%

“…12 Data were collected between September 10, 2008 and January 5, 2011 at three pediatric EDs associated with urban teaching hospitals: Children's National Medical Center in Washington, DC; Nationwide Children's Hospital in Columbus, OH; and Boston Children's Hospital in Boston, MA. Exclusion criteria were: 1) developmental disability, cognitive impairment, or communication disorder that interfered with the patient's ability to comprehend and communicate about the study; 2) triage level 1 (for medical/surgical patients), suggesting medical instability; 3) parent/guardian unavailable (for patients age 17 years and younger); and 4) patients and/or parents/guardians who were non-English speaking.…”

Section: Methodsmentioning

confidence: 99%

“…As previously reported, 12 for the larger study that developed the ASQ, a list of 17 candidate items was assembled and asked of all participants. The 17 candidate items were identified from several sources, including published literature, interviews with youth suicide experts and senior clinicians, and the Risk of Suicide Questionnaire.…”

Section: Methodsmentioning

confidence: 99%

“…This single item was not selected as part of the final 4-question model comprising the ASQ due to low agreement with the SIQ, as measured by the chance-corrected kappa statistic. 12 The final 4-item ASQ 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 (see Table 1). An answer of “yes” to any of the four ASQ items indicates a positive screen for clinically significant suicide risk that warranted further evaluation.…”

Section: Methodsmentioning

confidence: 99%

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Bullying and Suicide Risk Among Pediatric Emergency Department Patients

et al. 2016

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Objectives To describe the association between recent bullying victimization and risk of suicide among pediatric emergency department (ED) patients. Methods Patients presenting to one of three different urban pediatric EDs with either medical/surgical or psychiatric chief complaints completed structured interviews as part of a study to develop a suicide risk screening instrument, the Ask Suicide-Screening Questions (ASQ). Seventeen candidate items and the criterion reference Suicidal Ideation Questionnaire (SIQ) were administered to patients ages 10 to 21 years. Bullying victimization was assessed by a single candidate item (“In the past few weeks, have you been bullied or picked on so much that you felt like you couldn't stand it anymore?”). Results A total of 524 patients completed the interview (34.4% psychiatric chief complaints; 56.9% female; 50.4% white, non-Hispanic; mean age 15.2±2.6 years). Sixty patients (11.5%) reported recent bullying victimization, and of these, 33 (55.0%) screened positive for suicide risk on the ASQ or the previously validated SIQ. After controlling for demographic and clinical variables, including a history of depression and drug use, the odds of screening positive for suicide risk were significantly greater in patients who reported recent bullying victimization (adjusted odds ratio=3.19, 95% CI=1.66-6.11). After stratification by chief complaint, this association persisted for medical/surgical patients but not for psychiatric patients. Conclusions Recent bullying victimization was associated with increased odds of screening positive for elevated suicide risk among pediatric emergency department patients presenting with medical/surgical complaints. Understanding this important correlate of suicide risk in pediatric emergency department patients may help inform ED-based suicide prevention interventions.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Bullying and Suicide Risk Among Pediatric Emergency Department Patients

et al. 2016

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“…Additionally, studies examining higher-risk subgroups of ED patients (e.g. youth presenting with suicidal ideation or history of peer violence) also support this association among youth (Horowitz et al, 2012; King et al, 2009; Ranney et al, 2011; Ranney et al, 2013). …”

Section: Introductionmentioning

confidence: 88%

Prevalence and Correlates of Depression and Drinking Behaviors Among Adolescents and Emerging Adults in a Suburban Emergency Department

Patton

Lau

Blow

et al. 2015

Substance Use & Misuse

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Background Both alcohol use and depression are concerning health issues among youth. The Emergency Department (ED) is a critical location to access youth with depressive symptoms and alcohol misuse. Objectives To inform future interventions in the ED, this study examined the relationship between drinking behaviors and depressive symptoms among youth seeking ED care. Methods Youth ages 14-20 were recruited from a level-1 trauma ED located in the Midwest as part of a larger ongoing study. Participants completed an electronic screening survey, which included assessment of alcohol use, depressive symptoms, and demographic variables. Two logistic regression models were conducted to assess the relationship between depressive symptoms with alcohol consumption and specific alcohol-related consequences. Results Among 3,659 participants, bivariate analysis indicated that individuals screening positive for depression were more likely to be female, non-white, receive public assistance, and report higher scores on both alcohol consumption and alcohol-related consequences. Regression analyses indicated alcohol consumption, inability to stop drinking once starting, and feelings of guilt or remorse after drinking were significantly positively related to screening positive for depression. Conclusions/Importance Current findings support use of the ED as a location for identifying youth who are experiencing co-morbid alcohol use and depressive symptoms. Future research should focus on the effectiveness of brief intervention in the ED that focuses on the co-occurrence of alcohol misuse and depressive symptoms among youth.

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Screening for Depression and Suicide Risk in Children and Adolescents

Viswanathan

Wallace

Middleton

et al. 2022

JAMA

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ImportanceDepression, suicidal ideation, and self-harm behaviors in youth are associated with functional impairment and suicide.ObjectiveTo review the evidence on screening for depression or suicide risk in children and adolescents to inform the US Preventive Services Task Force (USPSTF).Data SourcesPubMed, Cochrane Library, PsycINFO, CINAHL, and trial registries through July 19, 2021; references, experts, and surveillance through June 1, 2022.Study SelectionEnglish-language, randomized clinical trials (RCTs) of screening for depression or suicide risk; diagnostic test accuracy studies; RCTs of psychotherapy and first-line pharmacotherapy; RCTs, observational studies, and systematic reviews reporting harms.Data Extraction and SynthesisTwo reviewers assessed titles/abstracts, full-text articles, and study quality and extracted data; when at least 3 similar studies were available, meta-analyses were conducted.Main Outcomes and MeasuresTest accuracy, symptoms, response, remission, loss of diagnosis, mortality, functioning, suicide-related events, and adverse events.ResultsTwenty-one studies (N = 5433) were included for depression and 19 studies (N = 6290) for suicide risk. For depression, no studies reported on the direct effects of screening on health outcomes, and 7 studies (n = 3281) reported sensitivity of screening instruments ranging from 0.59 to 0.94 and specificity from 0.38 to 0.96. Depression treatment with psychotherapy was associated with improved symptoms (Beck Depression Inventory pooled standardized mean difference, −0.58 [95% CI, −0.83 to −0.34]; n = 471; 4 studies; and Hamilton Depression Scale pooled mean difference, −2.25 [95% CI, −4.09 to −0.41]; n = 262; 3 studies) clinical response (3 studies with statistically significant results using varying thresholds), and loss of diagnosis (relative risk, 1.73 [95% CI, 1.00 to 3.00; n = 395; 4 studies). Pharmacotherapy was associated with improvement on symptoms (Children’s Depression Rating Scale–Revised mean difference, −3.76 [95% CI, −5.95 to −1.57; n = 793; 3 studies), remission (relative risk, 1.20 [95% CI, 1.00 to 1.45]; n = 793; 3 studies) and functioning (Children’s Global Assessment Scale pooled mean difference, 2.60 (95% CI, 0.78 to 4.42; n = 793; 3 studies). Other outcomes were not statistically significantly different. Differences in suicide-related outcomes and adverse events for pharmacotherapy when compared with placebo were not statistically significant. For suicide risk, no studies reported on the direct benefits of screening on health outcomes, and 2 RCTs (n = 2675) reported no harms of screening. One study (n = 581) reported on sensitivity of screening, ranging from 0.87 to 0.91; specificity was 0.60. Sixteen RCTs (n = 3034) reported on suicide risk interventions. Interventions were associated with lower scores for the Beck Hopelessness Scale (pooled mean difference, −2.35 [95% CI, −4.06 to −0.65]; n = 644; 4 RCTs). Findings for other suicide-related outcomes were mixed or not statistically significantly different.Conclusion and RelevanceIndirect evidence suggested that some screening instruments were reasonably accurate for detecting depression. Psychotherapy and pharmacotherapy were associated with some benefits and no statistically significant harms for depression, but the evidence was limited for suicide risk screening instruments and interventions.

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Ask Suicide-Screening Questions (ASQ)

Cited by 413 publications

References 24 publications

Bullying and Suicide Risk Among Pediatric Emergency Department Patients

Bullying and Suicide Risk Among Pediatric Emergency Department Patients

Prevalence and Correlates of Depression and Drinking Behaviors Among Adolescents and Emerging Adults in a Suburban Emergency Department

Screening for Depression and Suicide Risk in Children and Adolescents

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