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Validation and Feasibility of the ASQ Among Pediatric Medical and Surgical Inpatients
Lisa M Horowitz1, Elizabeth A Wharff2, Annabelle M Mournet3
1Office of the Clinical Director and horowitzl@mail.nih.gov.
Insights
The Ask Suicide-Screening Questions (ASQ) tool effectively identifies suicide risk in hospitalized children and adolescents. This brief screening is validated for use in medical and surgical units, proving feasible and acceptable to patients and parents.
Area of Science:
- Pediatric Medicine
- Psychiatry
- Clinical Psychology
Background:
- Pediatric inpatient settings require validated tools for suicide risk assessment.
- The Ask Suicide-Screening Questions (ASQ) is a brief instrument designed for suicide risk screening.
Purpose of the Study:
- To validate the Ask Suicide-Screening Questions (ASQ) instrument for pediatric medical and surgical inpatients.
- To assess the feasibility and acceptability of suicide risk screening in this population.
Main Methods:
- A cross-sectional study involving 600 pediatric patients (10-21 years) on inpatient medical and surgical units.
- The ASQ was validated against the Suicidal Ideation Questionnaire as the criterion standard.
- Patient and parent opinions on screening were assessed for feasibility.
Main Results:
- The ASQ demonstrated strong psychometric properties: sensitivity 96.67%, specificity 91.05%, negative predictive value 99.81%, and AUC 0.94.
- Acute positive screens for suicidal ideation were rare (0.5%), while non-acute positive screens (12.8%) and past attempts (8.0%) were noted.
- The ASQ accurately identified elevated suicide risk in the study population.
Conclusions:
- The 4-item ASQ is a valid and reliable tool for detecting elevated suicide risk in pediatric medical and surgical inpatients.
- Suicide risk screening using the ASQ is feasible and acceptable in these settings.
- The ASQ facilitates the detection of suicidal thoughts and behaviors in hospitalized youth.
Objectives:
To validate the use of a brief suicide risk screening tool, the Ask Suicide-Screening Questions (ASQ) instrument, in pediatric inpatient medical and surgical settings.
Methods:
Pediatric patients (10-21 years) hospitalized on inpatient medical and surgical units were recruited through convenience sampling for participation in a cross-sectional instrument validation study. The Suicidal Ideation Questionnaire was used as a standard criterion to validate the ASQ. Patient opinions about screening and parent consent to enroll in a suicide risk screening study were assessed to determine the feasibility of administering the ASQ in this venue.
Results:
A total of 600 pediatric medical inpatients were screened. Compared with the gold standard, the ASQ had strong psychometric properties, with a sensitivity of 96.67% (95% confidence interval [CI]: 82.78 to 99.92), a specificity of 91.05% (95% CI: 88.40 to 93.27), a negative predictive value of 99.81% (95% CI: 98.93 to 99.99), and an area under curve of 0.94 (95% CI: 0.90 to 0.97). Only 3 participants (0.5%) had acute positive screen results on the ASQ, endorsing current suicidal ideation, whereas 77 participants (12.8%) screened nonacute positive, and 48 participants (8.0%) reported a past suicide attempt.
Conclusions:
The brief 4-item ASQ is a valid tool to detect elevated suicide risk in pediatric medical and surgical inpatients. Our findings also reveal that screening is feasible in terms of detection of suicidal thoughts and behaviors and is acceptable to parents and patients.
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