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Abstract
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Because suicide is a principal cause of adolescent mortality, preventing suicide is an urgent task. To this end, Horowitz and et al have completed an impressive series of studies leading to the development of a suicide risk screen, the Ask Suicide Questions (ASQ) instrument that can be used in medical settings for children and adolescents. In this journal, this group examines whether the ASQ is superior to a commonly used mental health screener, the Patient Health Questionnaire-adolescent version (PHQ-A), as means to identify hospitalized youths at increased risk of suicide. Here, we discuss what Horowitz et al. have achieved and discuss next research questions on the hospital screening of adolescents for suicide prevention.
In a sample of 600 youths aged 10-21 years admitted to urban pediatric hospitals, Horowitz et al. studied how well each instrument predicted scores on a gold standard suicide risk instrument, the Suicidal Ideation Questionnaire. Impressively, the ASQ identified 97% of those youths who were positive on the Suicidal Ideation Questionnaire, compared with only 70% for the PHQ-A. Therefore, the ASQ will detect many youths who may be at risk for suicide but who would be missed by the PHQ-A. However, the false-positive rate (FPR) of the ASQ was 9%, more than twice the 4% of the PHQ-A. Because most youths admitted to the hospital for medical treatment are not at suicide risk, a 9% FPR can pose significant challenges with postscreening follow-up. So, the next question in suicide risk screening research should be, "can we reduce the FPR?"
One possible way to reduce the FPR of a screen is to use a computerized adaptive test to personalize the questions to the patient in response to the patient's answers. If there is uncertainty about whether a patient has a condition based on the patient's initial responses, a computerized adaptive test will ask additional questions to reduce that uncertainty, thereby reducing both false-positive and false-negative errors. In a recent study, King et al. report the development of a suicide risk computerized adaptive test, the Computerized Adaptive Screen for Suicidal Youth (CASSY). (The CASSY uses questions from the ASQ, among other sources.) King et al. clinically validated the CASSY based on its ability to predict suicide attempts within three months of an index visit. The predictions of the ASQ and the CASSY have not yet been compared in a head-to-head study, and this should be another of the next research questions investigated...
Language: en |