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CASSY Better Than ASQ for Predicting Suicide Attempts in Teens With Psychiatric Symptoms
A comparison of the Ask Suicide-Screening Questions (ASQ) and the Computerized Adaptive Screen for Suicidal Youth (CASSY) instruments found both tools showed strong predictive validity in predicting suicide attempts in adolescents over a 3-month period, although the CASSY ultimately offered higher accuracy among adolescents with psychiatric symptoms.
Researchers reported their findings in JAMA Network Open.
“The ASQ is a 4-item questionnaire that surveys suicidal ideation and lifetime suicide attempts. A positive response or nonresponse on any item indicates suicidal risk,” wrote corresponding author David A. Brent, MD, University of Pittsburgh School of Medicine and UPMC Western Psychiatric Hospital, Pittsburgh, Pennsylvania, and coauthors. “The CASSY is a computerized adaptive screening tool that always includes 3 ASQ items and a mean of 8 additional items.”
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The study included 2740 adolescents who presented at US emergency departments between July 24, 2017, and October 29, 2018, and completed both screenings as well as a 3-month follow-up to assess the actual occurrence of suicidal behavior. Among participants, 62.2% were female, 17.1% were Black, 24.7% were Hispanic, and 59.1% were white. The mean age was 15 years.
The instruments showed similar sensitivity, specificity, positive predictive value, and negative predictive value, according to the study. Specifically, sensitivity was 0.951 with the ASQ and 0.945 with the CASSY, specificity was 0.588 with the ASQ and 0.643 with the CASSY, positive predictive value was 0.127 with the ASQ and 0.144 with the CASSY, and negative predictive value was 0.995 for both.
For adolescents with physical symptoms, which accounted for most of the emergency department visits, area under the receiver operating characteristic curve (AUROC) results were also similar: 0.88 with the ASQ and 0.94 with the CASSY. For adolescents with psychiatric symptoms, the CASSY had a higher AUROC: 0.72, compared with 0.57 for the ASQ.
The instruments performed similarly for Black, Hispanic, and white adolescents, the study showed. The main advantages of the ASQ include its brevity, simplicity in administration, and free cost. CASSY’s primary advantages include its dimensionality and better accuracy in adolescents with psychiatric symptoms, who comprise a small but growing population, researchers pointed out.
“The similarity of the 2 measures in sensitivity, specificity, positive predictive value, and negative predictive value suggest that both instruments will perform well for universal screening in emergency departments,” the authors wrote. “Emergency department clinicians will need to decide which measure is best suited to their milieu and patient mix. Both the ASQ and the CASSY are worthy of consideration for identifying youths in the emergency department at risk for suicide.”
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