Validation of the Ask Suicide-Screening Questions (ASQ) in the Inpatient Medical Setting

Physicians and nurses working in non-mental health settings require tools to guide them in
recognizing patients at risk. While screening children and adolescents is emerging as a
priority of the Joint Commission, there are currently no suicide screening instruments
designed specifically for assessing suicide risk in a pediatric inpatient medical population.
Recently, our study team developed the Ask Suicide-Screening Questions (ASQ), a 4-item
suicide risk screening instrument with excellent sensitivity, specificity, and negative
predictive value for use in pediatric emergency departments (Protocol #08-M-N070). However,
use of the ASQ in an inpatient medical setting has not been tested. The aim of this study is
to determine the utility of the ASQ among pediatric medical inpatients in children s
hospitals. While most inpatients will not be at imminent risk for suicide, we hypothesize
that the ASQ will capture a number of patients who screen positive and are not only at risk
for suicidal behavior in the future, but are also experiencing significant emotional distress
and therefore warrant further psychiatric evaluation and follow-up treatment. This will be a
multisite study, comprised of medically ill inpatients at three non-NIH affiliated sites
(Children s National Medical Center, Boston Children s Hospital, and Nationwide Children s
Hospital), with a total sample size of 600 (200 per site). We will administer several short
measures of suicide risk the ASQ, the Suicidal Ideation Questionnaire, a brief depression
screen, the Patients Health Questionnaire Adolescent version (PHQ-A) to all eligible
inpatients aged 10-21 years. The ultimate goal of this project is to provide non-mental
health clinicians with a brief, accurate assessment tool for detecting risk of suicide in
pediatric medical inpatients and in turn, connecting those in need with mental health
services. After validating the ASQ with pediatric medical inpatients, we will then examine
the practical implications of nurses administering the ASQ as standard of care during the
admission process on a pediatric medical inpatient unit. Future studies will focus on
validating the ASQ in non-English speaking patients, addressing a critical gap in suicide
prevention research. In addition, examining the long-term clinical impact of screening
general medical patients for suicide risk with the ASQ and linking those in need with mental
health services and/or other interventions will be important next steps.

Please note: This is a multi-site study that is being conducted at three non-NIH sites, all
children s hospitals, all of which have already received IRB approval (Boston Children s
Hospital, Children s National Medical Center and Nationwide Children s Hospital). The CNS IRB
requires that we have an NIMH parent protocol even though no NIH patients will be enrolled at
the Clinical Center. Consent and patient data collection will take place on inpatient medical
units at those three sites; data will be sent to NIMH, and stored and analyzed here.

- INCLUSION CRITERIA:

All pediatric medical inpatients, aged 10 to 21 years, who are current inpatients on
selected medical units at the three different sites during data collection weeks, will be
approached for enrollment. Patients will be included if: 1) they are admitted as an
inpatient from Sunday at 7am through Thursday 11:59pm and 2) they have a parent or legal
guardian who is present to sign informed consent (for patients under 18 years of age)

EXCLUSION CRITERIA:

Patients will be excluded if: 1) they have severe developmental delays, cognitive
impairment, or communication disorder such that the patient is not able to comprehend
questions or communicate their answers; 2) their illnesses are so severe that the study
staff feels that they may not able to comprehend questions or communicate their answers; 3)
they have primarily psychiatric disorders and are boarding ; 4) parents/guardians