Background: Healthcare providers in Ethiopia require validated tools to screen paediatric patients for suicide risk in Amharic, the official language of Ethiopia. Objective: This study aimed to examine the psychometric properties of the Ask Suicide-Screening Questions (ASQ) tool in Amharic among Ethiopian paediatric patients. Method: This cross-sectional instrument validation study was conducted from February 2021 to September 2022. Paediatric patients were recruited from the emergency department, outpatient clinics, and medical inpatient units at Tikur Anbessa Specialised Hospital in Addis Ababa, Ethiopia. Paediatric patients (aged 10 to 18 years, inclusive) were enrolled. Participants completed the Amharic language version of the ASQ, the index test. A brief suicide safety assessment administered by a clinician served as the reference standard for validation. Results: A total of 159 paediatric patients were enrolled; 42 youth (26%) screened positive on the ASQ, and 10 (6%) were deemed "at risk" for suicide by a clinician. Compared to the reference standard, the ASQ had a sensitivity of 1.000 (95% confidence interval [CI]: 1.000 to 1.000), specificity of 0.785 (95% CI: 0.719 to 0.851), and area under the curve value of 0.890 (95% CI: 0.860 to 0.926). While most youth (n = 117; 74%) felt comfortable being screened for suicide risk, only 52.2% (n = 83) thought medical providers should ask youth about suicide. Conclusions: The Amharic version of the ASQ demonstrated strong psychometric properties and appears to be a valid suicide risk screening tool in the sample population. Future research should explore the feasibility and acceptability of screening Ethiopian paediatric patients for suicide risk.

Purpose: Lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) youth are at high suicide risk. Family/peer connectedness may be protective factors; few studies assess social connectedness within cisgender lesbian, gay, bisexual, and queer (cis-LGBQ) and transgender and gender-diverse (TGD) samples. This study aims to identify associations between family/peer connectedness and suicidal thoughts/behaviors (STBs) among cisgender-LGBQ and TGD youth to better inform suicide prevention strategies. Methods: This study utilized data from LGBTQ youth aged 12-17 in the Emergency Department Screen for Teens at Risk for Suicide study. Youth completed measures for STBs (Ask Suicide-Screening Questions and Columbia Suicide Severity Rating Scale) and family/peer connectedness ("low," "moderate," and "high"). Logistic regression analyses examined associations between family/peer connectedness and STBs in cis-LGBQ and TGD youth. Results: 53.2% (607/1,140) of cis-LGBQ and 69.7% (99/142) of TGD youth self-reported STBs. For cis-LGBQ youth, the odds of reporting STBs increased when comparing low/moderate versus high family connectedness (p < .001, adjOR = 9.8[6.8-14.2]; p < .001, adjOR = 3.5[2.7-4.7]) and low versus moderate (p < .001, adjOR = 2.8[1.9-4.0]). Regarding cis-LGBQ peer connectedness, the odds of reporting STBs increased when comparing low/moderate versus high (p < .01, adjOR = 1.8[1.2-2.7]; p < .05, adjOR = 1.5[1.1-2.1]), not low versus moderate (p = .4). For TGD youth, the odds of reporting STBs significantly increased when comparing low/moderate versus high family connectedness (p < .001, adjOR = 9.8[3.7-28.2]; p < .001, adjOR = 7.7[2.8-22.8]), not when comparing low versus moderate (p = .7). Peer connectedness levels had no significant associations with TGD youths' STB rates (p = .2, p = .3, p = .8). Discussion: LGBTQ, especially TGD youth, are at elevated suicide risk. High levels of family connectedness may especially help mitigate suicide risk in TGD youth. Future research should replicate findings in larger TGD samples and adapt LGBTQ-specific, family-based emergency department interventions.

Background: Medically ill adults are at elevated risk for suicide. Chronic pain and hopelessness are associated with suicide; however, few studies have examined the interaction between chronic pain and hopelessness in predicting suicide risk among hospitalized adults. Objective: This study aimed to describe the association between chronic pain, hopelessness, and suicide risk, defined fi ned as recent suicidal ideation or lifetime suicidal behavior. In addition, we examined the interaction between chronic pain and hopelessness. Methods: This was a secondary analysis of a multisite study to validate the Ask Suicide-Screening Questions (ASQ) among adult medical inpatients. Participants reported if they experienced chronic pain that impacted daily life and if they felt hopeless about their medical condition and provided their current pain rating on a 1 to 10 scale, with 10 being the most severe pain. A t-test compared pain severity scores by ASQ outcome. A binary logistic regression model described the association between chronic pain, hopelessness, and suicide risk; parameter estimates are expressed as odds ratios (OR) for interpretation. The interaction between chronic pain and hopelessness was examined in both the transformed (logit) and natural (probability) scales of the generalized linear model. Results: The sample included 720 participants (53.2% male, 62.4% White, mean age: 50.1 [16.3] years, range = 18-93). On the ASQ, 15.7% (113/720) of patients screened positive. Half (360/720) of the sample self- reported chronic pain. Individuals who screened positive had higher pain rating scores than those who screened negative (t =-4.2, df = 147.6, P < 0.001). Among all patients, 27.2% (196/720) felt hopeless about their medical condition. In the logistic regression model, patients with chronic pain (adjusted OR: 2.29, 95% confidence fi dence interval [CI]: 1.21-4.43, P = 0.01) or hopelessness (adjusted OR: 5.69, 95% CI: 2.52-12.64, P < 0.001) had greater odds of screening positive on the ASQ. The interaction effect between pain and hopelessness was not significant fi cant in the transformed (B =-0.15, 95% CI:-1.11 to 0.82, P = 0.76) or natural (B = 0.08, 95% CI:-0.07 to 0.23, P = 0.28) scale. Conclusions: There were significant fi cant independent associations between (1) chronic pain and suicide risk and between (2) hopelessness and suicide risk. Future research should examine the temporality and mechanisms underlying these relationships to inform prevention efforts for medically ill adults. (Journal of the Academy of Consultation-Liaison Psychiatry 2024; 65:126-135)

BACKGROUND:Suicide and suicidal behaviors pose significant global public health challenges, especially among young individuals. Effective screening strategies are crucial for addressing this crisis, with depression screening and suicide-specific tools being common approaches. This study compares their effectiveness by evaluating the Ask Suicide-Screening Questions (ASQ) against item 9 of the Patient Health Questionnaire-A (PHQ-A). METHODS:This study is a secondary analysis of the Argentinean-Spanish version of the ASQ validation study, an observational, cross-sectional, and multicenter study conducted in medical settings in Buenos Aires, Argentina. A convenience sample of pediatric outpatients/inpatients aged 10 to 18 years completed the ASQ, PHQ-A, and Suicide Ideation Questionnaire (SIQ) along with clinical and sociodemographic questions. RESULTS:A sample of 267 children and adolescents were included in this secondary analysis. Results show that the ASQ exhibited higher sensitivity (95.1%; 95% CI: 83% - 99%) compared to PHQ-A item 9 (73.1%; 95% CI: 57% - 85%), and superior performance in identifying suicide risk in youth. LIMITATIONS:The study included a convenience sampling and was geographically restricted to Buenos Aires, Argentina. The study also lacked longitudinal follow-up to assess the predictive validity of these screening tools for suicide risk. CONCLUSION:The study highlights the ASQ's effectiveness in identifying suicide risk among youth, emphasizing the importance of specialized screening tools over depression screening tools alone for accurate risk assessment in this population.

Leading medical organizations, such as the AAP, recommend suicide risk screening to identify patients at risk and connect them to mental health services. Outpatient podiatric medical/surgical clinics serve patients who frequently report chronic pain/illness (eg, diabetes) or injuries, which are associated with elevated suicide risk. The aim of this quality improvement (QI) study is to describe the feasibility of suicide risk screening in novel medical settings and highlight the importance of collaborations between nonpsychiatric clinicians and local mental health clinicians in suicide prevention practices.

Background: The high frequency of suicide risk in adolescents necessitates the development and validation of specific tools for systematic screening. To date, there are translated, but not validated suicide risk screening tools in Spanish. Objective: To validate the Spanish version of the Ask Suicide-Screening Questions (ASQ) for suicide risk screening in pediatric patients in Argentina.Method: Using a cross-sectional multicenter design, a convenience sample of pediatric patients aged 10 to 18 years old were recruited from outpatient/inpatient medical settings and private psychiatric clinics. The Spanish version of the Suicidal Ideation Questionnaire (SIQ) assessment tool was used as a standard criterion to validate the ASQ.Results: A total of 301/380 pediatric patients were screened for suicide risk. Twentyeight percent of the entire sample (83/301) of youth screened positive on the ASQ, and 21% (62/301) screened positive on the SIQ/SIQ-JR and were considered "at risk" for suicide. Compared with the SIQ, the Spanish ASQ yielded a sensitivity of 96.8% (95% Confidence Interval [CI]: 88.8-99.6%), specificity of 90.4% (95% CI: 85.9-93.8%), positive predictive value of 72.3% (95 CI: 61.4-81.6%), and negative predictive value of 99.1% (95% CI: 96.7-99.9%). The positive Likelihood Ratio (LR) was 10.1 (95% CI: 6.1-14.0), and the negative LR was 0.03 (95% CI: -0.01-0.09). Kappa was 0.77 (95% CI: 0.69-0.86), and the Area Under the Curve was 0.94 (95% CI: 0.91-0.97).Conclusion: The Spanish language ASQ demonstrated strong psychometric properties, providing initial evidence that it is a valid tool for identifying Spanish-speaking youth at risk for suicide.

Suicide and suicidal behavior among youth and young adults are a major public health crisis, exacerbated by the COVID-19 pandemic and demonstrated by increases in suicidal ideation and attempts among youth. Supports are needed to identify youth at risk and intervene in safe and effective ways. To address this need, the American Academy of Pediatrics and the American Foundation for Suicide Prevention, in collaboration with experts from the National Institute of Mental Health, developed the Blueprint for Youth Suicide Prevention ( Blueprint ) to translate research into strategies that are feasible, pragmatic, and actionable across all contexts in which youth live, learn, work, and play. In this piece, we describe the process of developing and disseminating the Blueprint. Through a summit and focus meetings, cross-sectoral partners convened to discuss the context of suicide risk among youth; explore the landscape of science, practice, and policy; build partnerships; and identify strategies for clinics, communities, and schools-all with a focus on health disparities and equity. These meetings resulted in 5 major takeaways: (1) suicide is often preventable; (2) health equity is critical to suicide prevention; (3) individual and systems changes are needed; (4) resilience should be a key focus; and (5) cross-sectoral partnerships are critical. These meetings and takeaways then informed the content of the Blueprint , which discusses the epidemiology of youth and young adult suicide and suicide risk, including health disparities; the importance of a public health framework; risk factors, protective factors, and warning signs; strategies for clinical settings, strategies for community and school settings; and policy priorities. Following the process description, lessons learned are also discussed, followed by a call to action for the public health community and all who serve and support youth. Finally, key steps to establishing and sustaining partnerships and implications for policy and practice are discussed.

The purpose of this study was to describe the feasibility of implementing suicide risk screening in a virtual addiction clinic. Suicide risk screening was implemented in a virtual addiction clinic serving individuals with substance use disorders (SUD) using a quality improvement framework. One-hundred percent (252/252) of eligible patients enrolled in the clinic were screened for suicide risk (44% female; M[SD] age = 45.0[11.0] years, range = 21–68 years). Nineteen patients (8%) screened positive for suicide risk. After screening, no patients required emergency suicide interventions (100% non-acute positive). Notably, 74% (14/19) of those who screened positive did so by endorsing at least one past suicide attempt with no recent ideation. Suicide risk screening in virtual addiction clinics yields important clinical information for high-risk SUD populations without overburdening workflow with emergency services. Given the high proportion of non-acute positive screens based on suicide attempt histories with no recent ideation, clinicians may utilize information on suicide attempt history to facilitate further mental healthcare.

Background:Non-suicidal self-injury (NSSI) is a potent risk factor for suicide among youth. There is limited research, however, on the association between NSSI and suicide risk among adults, particularly among adult medical patients, who are a population at increased risk for suicide. To address this research gap, the current analysis aimed to describe the association between lifetime history of NSSI and suicide risk in an adult medical inpatient population. Method:Adult medical inpatients aged 18 or older from one of four United States hospitals were screened for suicide risk and a lifetime history of NSSI. Suicide risk was determined using the Ask Suicide-Screening Questions (ASQ). NSSI history, methods, frequency, and severity were assessed via a structured interview based on the Self-Injurious Thoughts and Behaviors Interview. Results:A total of 621 adult medical inpatients were included in this secondary analysis (55.2% male; 60.9% White; M[SD] age = 50.3[16.7]); 5.8% of patients (36/621) reported a lifetime history of NSSI and 16.1% (100/621) screened positive for suicide risk. Patients with a lifetime history of NSSI were significantly more likely to screen positive for suicide risk (OR = 9.4 [95% CI, 4.4-20.8]; p < .0001). Limitations:This analysis used cross sectional data and could not examine any causal relationships between NSSI and suicide risk. Conclusions:Adult medical inpatients with a lifetime history of NSSI were significantly more likely to screen positive for suicide risk. Research examining NSSI among adult medical patients is especially relevant for suicide risk detection and prevention efforts.

Early detection of risk is a key suicide prevention strategy. Given that most individuals who die by suicide visit a health care provider in the year leading up to their death, medical settings are ideal venues for identifying those at elevated risk and bridging them to life-saving care. Clinicians are presented with an opportunity to engage in proactive suicide prevention efforts through practical and adaptable suicide risk screening, assessment, and management processes. Psychiatrists and mental health clinicians are well positioned to assist nonpsychiatric clinicians on the frontlines of this public health problem. This article discusses the importance of identifying people at elevated suicide risk through screening, differentiates screening from assessment procedures, and presents practical strategies for implementing evidence-based screening and assessment tools into practice as part of a three-tiered clinical pathway. Specifically, this article discusses key components that guide embedding suicide prevention strategies into the workflows of busy medical settings.

Suicide is a serious public health concern. On average, 80% of suicide decedents had contact with primary care within 1 year of their suicide. This and other research underscore the importance of screening for suicide risk within primary care settings, and implementation of suicide risk screening is already underway in many practices. However, while primary care practices may be familiar with screening for other mental health concerns (e.g., depression), many feel uncomfortable or unprepared for suicide risk screening. To meet the increasing demand for evidence-based suicide-risk-screening guidance, we provide a clinical pathway for adult primary care practices (to include family medicine, internal medicine, women's health). The pathway was developed by experts with research, clinical expertise, and experience in suicide risk screening and primary care. We also provide detailed guidance to aid primary care practices in their decisions about how to implement the clinical pathway.

AIMS:Adolescents and young adults at clinical high risk (CHR) for psychosis report few close friends. Social support has been linked to conversion to psychosis and psychosis relapse in CHR individuals. Expanding earlier research on loneliness and friendships at a single timepoint, this study described composition and changes in social network and its association with clinical and cognitive symptoms among CHR adolescents.METHODS:Ninety five individuals (46 CHR individuals, 49 healthy volunteers) completed baseline and 1-year follow-up Social Network Index (SNI) evaluations and clinical interviews. Analyses first examined SNI size and composition across 10 categories (e.g., family, close friends, coworkers, classmates) between groups. Then, the relationship between SNI size and baseline social symptoms (i.e., paranoia, social anhedonia, social anxiety, social cognition), social function, and changes in symptoms and social networks over 1-year were examined within the CHR group.RESULTS:CHR individuals showed smaller social networks overall, driven by fewer friendships and family relationships. Social cognition and social anxiety significantly related to SNI size at baseline, but social anhedonia and paranoia did not. SNI size related to social function, but with a modest effect size (r's = .45 and .56). Surprisingly, an increase in positive symptom severity related to an increase in familial but a decrease in coworker social network size.CONCLUSIONS:The social support deficits in the CHR group were specific to relatives and friendships, with social anxiety and social cognition as implicated symptoms. Social relationships may serve as a promising early intervention target in individuals at CHR for psychosis.