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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

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Know the risks and potential benefits of clinical studies and talk to your health care provider before participating. Read our disclaimer for details. Identifier: NCT02140177
Recruitment Status : Recruiting
First Posted : May 16, 2014
Last Update Posted : April 26, 2019
Information provided by (Responsible Party):
National Institutes of Health Clinical Center (CC) ( National Institute of Mental Health (NIMH) )

Brief Summary:


- 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.


- 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.


- NIH Clinical Center patients over age 18.


  • 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.

Condition or disease
Depression Cancer Chronic Illness

Detailed Description:

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.

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Study Type : Observational
Estimated Enrollment : 810 participants
Time Perspective: Prospective
Official Title: Ask Suicide-Screening Questions to Everyone in Medical Settings (asQ'em): Development of a Suicide Risk Screening Instrument for Adult Medical Inpatients
Actual Study Start Date : June 1, 2014
Estimated Primary Completion Date : December 31, 2019
Estimated Study Completion Date : December 31, 2025

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Suicide

Primary Outcome Measures :
  1. Frequencies of positive responses to all asQem candidate items and ASIQ/BSI items. [ Time Frame: ongoing ]
    This outcome measure will assist in identifying which of the asQem candidate items are the most sensitive and specific to detecting suicide risk.

Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

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.


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).

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT02140177

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Contact: Lisa M Horowitz, Ph.D. (301) 435-6052

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United States, Maryland
Walter Reed National Military Medical Center Recruiting
Bethesda, Maryland, United States, 20889
United States, Rhode Island
Rhode Island Hospital Recruiting
Providence, Rhode Island, United States, 02903
United States, Texas
John Peter Smith Recruiting
Fort Worth, Texas, United States, 76104
Sponsors and Collaborators
National Institute of Mental Health (NIMH)
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Principal Investigator: Lisa M Horowitz, Ph.D. National Institute of Mental Health (NIMH)

Additional Information:
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Responsible Party: National Institute of Mental Health (NIMH) Identifier: NCT02140177     History of Changes
Other Study ID Numbers: 140109
First Posted: May 16, 2014    Key Record Dates
Last Update Posted: April 26, 2019
Last Verified: April 8, 2019
Keywords provided by National Institutes of Health Clinical Center (CC) ( National Institute of Mental Health (NIMH) ):
Medical Inpatients
Additional relevant MeSH terms:
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Chronic Disease
Behavioral Symptoms
Self-Injurious Behavior
Disease Attributes
Pathologic Processes