Ask Suicide-Screening Questions (ASQ): One Year Follow-up of Youth Screened for Suicide Risk in the Pediatric Emergency Department

Introduction: Emergency departments (EDs) are uniquely situated to identify young patients at risk for suicide. Brief screening instruments, like the Ask Suicide-Screening Questions (ASQ), can guide non-psychiatric clinicians in early detection and action during an ED visit. Associations between positive responses to suicide screening items and future healthcare utilization have important implications for how ED clinicians screen, manage, and treat patients at increased risk for suicide. The purpose of this presentation is to examine the association between screening positive on the ASQ and repeated ED visits for suicide-related concerns in the year following index ED visit.

Methods: Follow-up data from the ASQ multi-site instrument development study will be presented. These analyses focus on a subgroup of the larger ASQ development study. Two of the three participating medical centers collected data on repeat ED visits that occurred in the year following index ED visit. Presenting complaints and discharge diagnoses were recorded from medical record data and were dichotomized as “psychiatric” or “medical.” Psychiatric visits were further coded for the presence of suicidal thoughts or behavior. Visits were categorized for the presence of a suicide attempt or broadly for any suicidal event (i.e., ideation or behavior). Therefore, there were two potential study outcomes: 1.) ED visit for suicide attempt; 2.) ED visit for suicide event.

Results: Results from 325 participants, ages 10-21 years, will be presented. Overall, 227 participants presented to the ED for medical reasons and 98 presented for psychiatric reasons.  Of the psychiatric patients, 67% (n = 66) screened positive on the ASQ, while 12% (n = 28) of the medical patients screened positive on the ASQ. For the entire sample, 3/325 participants (1%) returned to the ED for a suicide attempt in the year after index ED visit. Each of these patients had screened positive on the ASQ at index visit (sensitivity: 100%). In addition, 6/325 participants (2%) returned to the ED for a suicide event; of those participants, 5 had screened positive on the ASQ at index visit (sensitivity: 83%).

Conclusions: The ASQ showed good sensitivity for predicting suicidal behavior at one year follow-up after index ED visit. Screening for suicide risk in the pediatric ED may be an important identification strategy for at-risk youth.