The National Institute of Mental Health (NIMH)’s Division of Intramural Research Programs has released the Ask Suicide-Screening Questions (ASQ) toolkit to help nurses and physicians identify youths aged 10 to 24 at risk for suicide.

Suicide is the second leading cause of death in young people aged 10 to 24 worldwide and is a major health concern in the United States. Suicide attempts and suicidal thoughts are even more common than death by suicide.

The early identification of patients at high risk for suicide is essential for suicide prevention. The majority of individuals who commit suicide visit a healthcare provider within months of their death, representing an important opportunity to intercede and connect them with mental health resources. However, few healthcare settings screen for suicide risk. In February 2016, the Joint Commission, the accrediting organization for healthcare programs in US hospitals, issued a Sentinel Event Alert recommending that all patients in all medical settings be screened for suicide.

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In 2008, NIMH initiated steps to develop and validate a suicide risk screening tool for youths in medical settings — the ASQ. It is a free resource for medical settings (emergency department, inpatient medical/surgical units, outpatient clinics/primary care). The ASQ is a set of 4 screening questions that take 20 seconds to administer. An NIMH study demonstrated that a “yes” response to 1or more of these questions identified 97% of youths at risk for suicide. The toolkit is available in multiple languages, including Spanish, Portuguese, French, Arabic, Dutch, Hebrew, Mandarin, and Korean.

Screening should be done without the parent/guardian present. However, if the parent or guardian refuses to leave the room or the child insists that they stay, the screening should still be conducted.

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Patients who screen positive for suicide risk on the ASQ should receive a brief suicide safety assessment (BSSA) conducted by a trained clinician to determine whether a more comprehensive mental health evaluation is required. Regardless of the outcome of the BSSA, the individual should receive the Patient Resource List.


Ask Suicide-Screening Questions (ASQ) Toolkit. National Institute of Mental Health. Accessed February 22, 2018.