Positive results on the Ask Suicide-Screening Questions (ASQ) may be helpful for identifying youths admitted to the emergency department (ED) who are at risk for suicidal behaviors, study results published in JAMA Network Open suggest.1

The 4-item ASQ is a screening tool that can be administered in 2 minutes by ED nurses without specialized training. This tool has previously been effective in identifying the suicide risk of youths admitted to the pediatric ED who had not reported suicidal thoughts or behaviors.2

Researchers performed a retrospective cohort study of youths (mean age, 14.5 years at baseline) who provided responses to the ASQ in an urban pediatric ED. The selective screening condition consisted of pediatric patients between age 8 to 18 years with behavioral and psychiatric problems, and the university screening condition consisted of patients between age 10 to 18 with medical presenting problems plus patients 8 to 18 years of age with behavioral and psychiatric presenting problems.

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The primary outcome was subsequent ED visits with suicide-related presenting problems, including ideation or attempts. This was assessed using electronic health records or death by suicide data.

The mean follow-up duration for the selective and universal conditions was 1133.7 days and 366.2 days, respectively. During these follow-up periods, there were 275 suicide-related ED visits and 3 deaths by suicide in the selective condition and 118 suicide-related ED visits and no deaths in the universal condition. A positive response to any of the ASQ questions was associated with an increased risk for suicide-related outcomes in the universal condition (hazard ratio [HR], 6.8; 95% CI, 4.2-11.1) and the selective condition (HR, 4.8; 95% CI, 3.5-6.5).

In the selective screening condition, the likelihood of post-admission suicide-related ED visits varied by race/ethnicity (HR for Latino vs non-Latino respondents, 1.7; 95% CI, 1.1-2.8). The likelihood of subsequent suicide-related ED visits was higher in patients admitted to the ED during their baseline visit (HR vs discharged, 1.4; 95% CI, 1.1-1.8).

Study limitations include its retrospective nature, as well as the lack of follow-up data for patients who were not screened with the ASQ.

In addition to utilizing the ASQ in pediatric patients visiting to the ED, the researchers suggest “enhanced follow-up, care coordination, or other community-based prevention approaches are needed to prevent future suicidal behaviors in our patient population.”


1.     DeVylder JE, Ryan TC, Cwik M, et al. Assessment of selective and universal screening for suicide risk in a pediatric emergency Ddpartment. JAMA Netw Open. 2019;2(10):e1914070.

2.     Ballard ED, Cwik M, Van Eck K, et al. Identification of at-risk youth by suicide screening in a pediatric emergency department. Prev Sci. 2017;18(2):174-182.