Validity of the Nepali Ask Suicide Screening Questions tool for medical inpatients

Abstract Background Nepal has one of the highest youth suicide rates in the world. Suicide screening is rarely performed during hospitalization, partly due to the lack of validated tools in the local language. We evaluated the validity of the Nepali version of the Ask Suicide-Screening Questions (AS...

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Main Authors: Daman R Poudel, Arun K Sharma, Ram H Chapagain, Manisha Chapagai, Nathan J. Lowry, Mahesh R Sigdel, Krishna P Bista, Rahul Pathak, Arun Kunwar, Janna Patterson, Terrell Carter, Lisa M. Horowitz
Format: Article
Language:English
Published: BMC 2025-07-01
Series:BMC Psychiatry
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Online Access:https://doi.org/10.1186/s12888-025-07148-w
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author Daman R Poudel
Arun K Sharma
Ram H Chapagain
Manisha Chapagai
Nathan J. Lowry
Mahesh R Sigdel
Krishna P Bista
Rahul Pathak
Arun Kunwar
Janna Patterson
Terrell Carter
Lisa M. Horowitz
author_facet Daman R Poudel
Arun K Sharma
Ram H Chapagain
Manisha Chapagai
Nathan J. Lowry
Mahesh R Sigdel
Krishna P Bista
Rahul Pathak
Arun Kunwar
Janna Patterson
Terrell Carter
Lisa M. Horowitz
author_sort Daman R Poudel
collection DOAJ
description Abstract Background Nepal has one of the highest youth suicide rates in the world. Suicide screening is rarely performed during hospitalization, partly due to the lack of validated tools in the local language. We evaluated the validity of the Nepali version of the Ask Suicide-Screening Questions (ASQ) tool in youth population in medical inpatient settings. Methods We conducted a cross-sectional validation study at two urban hospitals in Nepal between January and July 2022. Patients aged 10 to 24 years admitted to medical wards were recruited through convenience sampling. Patients with significant cognitive impairment, non-fluent in Nepali, or planned early discharge limiting participation were excluded. Trained nurses administered the ASQ followed by the adolescent version of Patient Health Questionnaire (PHQ − 9) and completed a demographic survey. Thereafter a separate team of psychologists, blind to ASQ results, conducted a brief suicide safety assessment (BSSA) as the gold standard for suicide risk screening. Results All study procedures were completed by 309 [54.0% male, mean age = 15.79(± 4.2) years] participants and were included in analysis. In our sample, 15.9% (49/309) screened positive with ASQ; 8.4% (26/309) had elevated suicide risk on the BSSA. The ASQ demonstrated good sensitivity (77%; 95% CI: 56–91), specificity (90%; 95% CI: 86–93), positive predictive value (41%; 95% CI: 27–56) and negative predictive value (98%; 95% CI: 95–99) against BSSA. Conclusion The Nepali version of ASQ is a good, brief screening tool for identifying suicidal risk. Further validation in wider populations including outpatient setting and routine implementation in clinical practice should be considered.
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institution Kabale University
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spelling doaj-art-c0c06d3cd47f4fbabbd1da62538a709e2025-08-20T03:42:56ZengBMCBMC Psychiatry1471-244X2025-07-012511910.1186/s12888-025-07148-wValidity of the Nepali Ask Suicide Screening Questions tool for medical inpatientsDaman R Poudel0Arun K Sharma1Ram H Chapagain2Manisha Chapagai3Nathan J. Lowry4Mahesh R Sigdel5Krishna P Bista6Rahul Pathak7Arun Kunwar8Janna Patterson9Terrell Carter10Lisa M. Horowitz11Tribhuvan University Teaching Hospital, Institute of MedicineTribhuvan University Teaching Hospital, Institute of MedicineKanti Children’s HospitalTribhuvan University Teaching Hospital, Institute of MedicineNational Institute of Mental HealthTribhuvan University Teaching Hospital, Institute of MedicineNepal Paediatrics SocietyTribhuvan University Teaching Hospital, Institute of MedicineKanti Children’s HospitalAmerican Academy of PediatricsAmerican Academy of PediatricsNational Institute of Mental HealthAbstract Background Nepal has one of the highest youth suicide rates in the world. Suicide screening is rarely performed during hospitalization, partly due to the lack of validated tools in the local language. We evaluated the validity of the Nepali version of the Ask Suicide-Screening Questions (ASQ) tool in youth population in medical inpatient settings. Methods We conducted a cross-sectional validation study at two urban hospitals in Nepal between January and July 2022. Patients aged 10 to 24 years admitted to medical wards were recruited through convenience sampling. Patients with significant cognitive impairment, non-fluent in Nepali, or planned early discharge limiting participation were excluded. Trained nurses administered the ASQ followed by the adolescent version of Patient Health Questionnaire (PHQ − 9) and completed a demographic survey. Thereafter a separate team of psychologists, blind to ASQ results, conducted a brief suicide safety assessment (BSSA) as the gold standard for suicide risk screening. Results All study procedures were completed by 309 [54.0% male, mean age = 15.79(± 4.2) years] participants and were included in analysis. In our sample, 15.9% (49/309) screened positive with ASQ; 8.4% (26/309) had elevated suicide risk on the BSSA. The ASQ demonstrated good sensitivity (77%; 95% CI: 56–91), specificity (90%; 95% CI: 86–93), positive predictive value (41%; 95% CI: 27–56) and negative predictive value (98%; 95% CI: 95–99) against BSSA. Conclusion The Nepali version of ASQ is a good, brief screening tool for identifying suicidal risk. Further validation in wider populations including outpatient setting and routine implementation in clinical practice should be considered.https://doi.org/10.1186/s12888-025-07148-wValidationAsk Suicide-Screening questionsSuicideNepalYouthMental health
spellingShingle Daman R Poudel
Arun K Sharma
Ram H Chapagain
Manisha Chapagai
Nathan J. Lowry
Mahesh R Sigdel
Krishna P Bista
Rahul Pathak
Arun Kunwar
Janna Patterson
Terrell Carter
Lisa M. Horowitz
Validity of the Nepali Ask Suicide Screening Questions tool for medical inpatients
BMC Psychiatry
Validation
Ask Suicide-Screening questions
Suicide
Nepal
Youth
Mental health
title Validity of the Nepali Ask Suicide Screening Questions tool for medical inpatients
title_full Validity of the Nepali Ask Suicide Screening Questions tool for medical inpatients
title_fullStr Validity of the Nepali Ask Suicide Screening Questions tool for medical inpatients
title_full_unstemmed Validity of the Nepali Ask Suicide Screening Questions tool for medical inpatients
title_short Validity of the Nepali Ask Suicide Screening Questions tool for medical inpatients
title_sort validity of the nepali ask suicide screening questions tool for medical inpatients
topic Validation
Ask Suicide-Screening questions
Suicide
Nepal
Youth
Mental health
url https://doi.org/10.1186/s12888-025-07148-w
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