Screening for Suicide Risk in the Medical Setting: Just ASQ

Introduction: Suicide in hospital settings is one of the most frequently reported sentinel events to the Joint Commission (JC). Over 1,000 inpatient deaths by suicide have been reported to the JC since 1995; notably, 25% occurred on non-behavioral health units. Lack of proper “assessment” was the leading root cause for 80% of hospital suicides. This poster aims to describe the methods and results of two studies designed to screen for suicide risk in medical patients. The Ask Suicide-Screening Questions (ASQ) study aimed to develop a suicide-screening tool for youth presenting to the pediatric emergency department (ED); the Ask Suicide-Screening Questions to Everyone in Medical Settings (asQ’em) Quality Improvement Project (QIP) examined the feasibility of nurses screening for suicide risk on inpatient medical/surgical units.

Methods: For the ASQ study, a convenience sample of pediatric patients presenting to the ED responded to 17 candidate items, the gold-standard Suicidal Ideation Questionnaire (SIQ), and a socio-demographic survey. Agreement between candidate items and SIQ items was examined. Logistic regression models were constructed to determine the best combination of candidate items with the strongest psychometric properties for identifying suicide risk as measured by the SIQ.

For the asQ’em QIP, a 2-item screening tool that assesses suicidal thoughts and behaviors, designed specifically for nurses to administer to medical inpatients was tested.  A convenience sample of adult patients, from three inpatient units in the National Institutes of Health Clinical Center, participated.

Results: In the ASQ study, 524 patients were screened. 98 (18.7%) patients screened “positive” for risk of suicide. Of note, 4% of the medical patients screened positive for suicide risk. A 4-item model with the strongest psychometric properties was selected (sensitivity = 96.9, specificity = 87.6, and negative predictive value = 99.7).

In the asQ’em QIP, 331 patients were screened. 13 (4%) patients screened “positive” for suicide risk. Screening took less than 2 minutes; 87% of patients reported feeling comfortable with screening. 81% of patients, 75% of nurses, and 100% of social workers (SW) agreed that all medical patients should be screened for suicide risk. 

Discussion: Screening for suicide in the medical setting is feasible. The ASQ study showed that the ED is a viable setting for implementing routine suicide screening among youth. The strong psychometrics of the ASQ tool will be discussed. The asQ’em QIP demonstrated that nurses can feasibly screen hospitalized medical/surgical patients for suicide risk with a 2-item screening tool. Quantitative and qualitative data collected from patients, nurses, SWs, and physicians will be presented from the asQ’em QIP.