Evaluation of the Ask Suicide-Screening Questions (ASQ) tool, Item 9 of the Patient Health Questionnaire (PHQ), pain, and opioid screening to detect suicide risk among rural adult primary care patients

Purpose

This study evaluated psychometric properties of the Ask Suicide-Screening Questions (ASQ) and Item Nine of the Patient Health Questionnaire (PHQ Item 9) to detect suicide risk in rural adult primary care and whether pain and opioid screening contributed to suicide risk detection.

Methods

A sample of adult rural primary care patients (N = 214) completed suicide risk, pain, and opioid screening measures electronically; 48% of participants also completed a follow-up survey. Using the Adult Suicidal Ideation Questionnaire (ASIQ) as the criterion measure, psychometric properties for the ASQ and the PHQ Item 9 were compared using McNemar's test for proportions. Bivariate and multivariable regression analyses explored associations between suicide risk, pain, opioid measures, and ASIQ results.

Findings

Approximately 4% (N = 8) of participants screened positive for suicide risk on the ASIQ relative to 11.7% (N = 25) on the ASQ and 3.7% (N = 8) on the PHQ Item 9. The ASQ had higher sensitivity (75.0%) than the PHQ Item 9 (50.0%); the difference was not statistically significant but may have clinical relevance. The PHQ Item 9 had significantly higher specificity (98.1%) than the full ASQ (91.0%, p < 0.001). The ASQ, PHQ Item 9, depression scores, and LGBTQ+ status were significant predictors of ASIQ scores. Pain and opioid misuse were not.

Conclusions

Findings from this small sample provide preliminary support for the ASQ and PHQ Item 9 as suicide risk screens in rural adult primary care, but psychometric studies in larger samples are needed.