Ask Suicide-Screening Questions to Everyone in Medical Settings (asQ em): Development of a Suicide Risk Screening Instrument for Adult Medical Inpatients



Status:Recruiting
Conditions:Cancer, Cancer, Depression, Depression, Psychiatric
Therapuetic Areas:Oncology, Psychiatry / Psychology
Healthy:No
Age Range:18 - Any
Updated:4/6/2019
Start Date:May 14, 2014
End Date:March 6, 2020
Contact:Lisa M Horowitz, Ph.D.
Email:horowitzl@mail.nih.gov
Phone:(301) 435-6052

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Ask Suicide-Screening Questions to Everyone in Medical Settings (asQ'em): Development of a Suicide Risk Screening Instrument for Adult Medical Inpatients

Background:

- Suicide is the 10th leading cause of death for U.S. adults. Medically ill people are at an
increased risk of suicide. Most people who have killed themselves went to a healthcare
provider within 3 months of their death. More and more, hospitals are being asked to assess
people for signs of suicide risk so that they can get the help they need. If nurses and
doctors can find out who is at risk they can make sure these people get help in the hospital.

The asQ em (Ask Suicide-Screening Questions to Everyone in Medical Settings) is a brief
questionnaire. It was created to detect suicidal thoughts and behaviors in hospitalized
people. Researchers would like to further develop this tool and figure out which are the best
questions to ask patients.

Objective:

- To determine the best questions for healthcare providers to ask people with medical
illnesses to see if they are having suicidal thoughts or planning to hurt themselves.

Eligibility:

- NIH Clinical Center patients over age 18.

Design:

- Participants will be asked questions about how they have been feeling in the past few
weeks. They will be asked questions about depression, anxiety, and suicidal thoughts and
behaviors. They also will be asked some background questions.

- It will take approximately 15 to 30 minutes to answer the questions.

In 2010, the Joint Commission (JC) issued a Sentinel Event Alert highlighting the need to
detect suicide risk in all non-behavioral patients in medical settings. Detecting suicide
risk among medical patients is important because this population is at elevated risk for
suicidal thoughts and behaviors, and because for many of these patients, a medical visit is
their only portal into mental health services. Of note, the vast majority of people who die
by suicide visit a medical setting, such as an inpatient oncology unit, more frequently than
a psychiatric setting in the months leading up to their death. Thus, the inpatient medical
setting is an important stakeholder in decreasing suicide-related morbidity and mortality.
Physicians and nurses working in non-mental health settings require tools to guide them in
recognizing patients at risk. Nonetheless, there are currently no suicide screening
instruments designed specifically for assessing suicide risk in an adult inpatient medical
population.

In 2012, our study team conducted a Quality Improvement Project (QIP) at the National
Institutes of Health Clinical Center (NIH CC) which demonstrated that the asQ em (Ask
Suicide-Screening Questions to Everyone in Medical Settings), a brief instrument piloted to
detect suicidal thoughts and behaviors among adult medical inpatients, was both feasible to
administer and acceptable to both patients and staff. Extending this work, the aim of this
current study is to further develop and psychometrically validate the asQ em among adult
medical inpatients. While most inpatients will not be at imminent risk for suicide, we
hypothesize that the asQ em will identify a number of patients who screen positive for
suicide risk on a longer gold standard instrument, and that they are thus not only at risk
for suicidal behavior in the future, but are also experiencing significant emotional distress
and therefore warrant further mental health evaluation and recommendations for follow-up
treatment.

This study will be a prospective, cross-sectional multisite study with patients enrolled from
the NIH CC, Walter Reed National Military Medical Center, Rhode Island Hospital, and John
Peter SmithHospital. The total planned sample size will be 810 (180 from WRNMMC, 180 from
RIH, 200 from JPS, and 250 from NIH CC). We will administer several short measures of suicide
risk: the 20 asQ em candidate items; a criterion standard Adult Suicidal Ideation
Questionnaire (ASIQ); two questions which assess for suicidal behavior from a second
criterion standard, the Beck Scale for Suicide Ideation (BSI); a brief depression screen, the
Patient Health Questionnaire (PHQ-9); and an exploratory variable questionnaire, to all
eligible inpatients aged 18 years and older. The ultimate goal of this project is the
development of a validated risk of suicide screening instrument that can be administered
rapidly by non-mental health clinicians to medical inpatients and in turn, connecting those
in need with mental health services. Additionally, we hope to pilot the Suicide Implicit
Association Test (S-IAT) in a subsample of recruited patients. The S-IAT is a brief computer
task which measures a person s implicit association between self and either life or death .
We expect to demonstrate that the S-IAT is feasible to administer in the inpatient medical
setting thereby providing a potential alternative to self-report questionnaires for assessing
patients thoughts about death or suicide.

Future studies will focus on examining the practical implications of nurses administering the
asQ em as standard of care during the admission process on a medical inpatient unit and
validating the asQ em 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 em and linking those in need with
mental health services and/or other interventions will be important next steps.

- INCLUSION CRITERIA:

All adult medical inpatients, ages 18 and older, who are admitted to selected medical units
during data collection weeks will be approached for enrollment. Patients will be included
if:

1. they are admitted as an inpatient on the designated medical units;

2. they are 18 and older;

3. they are capable of providing consent;

5) they have not previously been enrolled in this study.

EXCLUSION CRITERIA:

Patients will be excluded if:

1. they are medically or cognitively unable to participate in the screening or assessment
(e.g., sustained altered level of consciousness, psychosis, hostile behavior,
unremitting distress, intubation, persistent vomiting, severe pain, acute or worsening
medical acuity);

2. they have been already enrolled during a previous visit;

3. they are unwilling to provide consent;

4. the patient is non-English speaking (because ASIQ has not been validated in languages
other than English).
We found this trial at
3
sites
1500 South Main Street
Fort Worth, Texas 76104
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593 Eddy Street
Providence, Rhode Island 02903
401-444-4000
Rhode Island Hospital Founded in 1863, Rhode Island Hospital in Providence, RI, is a private,...
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Providence, RI
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8901 Rockville Pike
Bethesda, Maryland 20889
(301) 295-4000
Walter Reed National Military Medical Center The Walter Reed National Military Medical Center is one...
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Bethesda, MD
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