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Identifying Suicidality Risk in Adolescent Gynecology: Implications of Combined PHQ-2 and ASQ Screening
Mary A Nowlen1, Amy Williamson2, M'hamed Temkit3
1The University of Arizona College of Medicine - Phoenix, Department of Obstetrics and Gynecology, Phoenix, AZ.
Objective:
To evaluate the association between depression and suicidal ideation (SI) screening results among patients in a pediatric and adolescent gynecology clinic and to determine whether associations differ between school and summer periods.
Study Design:
This retrospective cross-sectional study included patients aged ≥ 13 years who completed both the Patient Health Questionnaire-2 (PHQ-2) and Ask Suicide Screening Questions (ASQ) from June 2023 to April 2025. Depression was defined as a PHQ-2 score ≥ 3; SI was defined as any affirmative ASQ response. Simultaneous positive/negative combinations were evaluated, and associations were tested using chi-square or Fisher's exact tests.
Results:
Among 1,481 patients, PHQ-2 and ASQ scores were significantly associated (p < 0.0001). Negative PHQ-2 screens corresponded to negative ASQ screens in 1,192 (92.5%) patients. However, 97 (7.5%) patients screened negative for depression but positive for SI, including one (0.1%) with severe SI. Positive ASQ screens were more frequently associated with positive PHQ-2 screens (40.6%) than negative PHQ-2 screens (7.5%). All severe ASQ scores occurred during the school year.
Conclusions:
Screening for depression alone is insufficient to identify all adolescents at risk for suicidality. Dual screening with PHQ-2 and ASQ enables more comprehensive identification of at-risk patients in pediatric and adolescent gynecology settings, thereby enabling practitioners to connect such patients with the necessary mental-health resources.
