Calculators / Suicide risk
ASQ
Ask Suicide-Screening Questions. Brief suicide risk screen for medical and mental health settings.
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The ASQ calculator is in the Library.
Every rating scale calculator comes with the Library, along with the prescribing guides, medication handouts, DSM-5 criteria and sheets, and the Guide Builder.
Use it for
- Screening patients for suicide risk in the emergency department, on inpatient units and in primary care, including by clinicians who are not mental health specialists.
- Deciding who needs a safety assessment, and how fast.
- Prompting a direct conversation about suicide.
Do not use it for
- Predicting who will attempt or die by suicide. A screen finds people who need an assessment. It does not rate their risk.
- A full risk assessment. A positive screen starts one, and a mental health clinician finishes it.
- Replacing clinical judgment. A negative screen can be overridden by what you see and hear.
Ask the four questions in order. If the person answers yes to any of them, or declines to answer, count it as a positive screen and ask question 5. A refusal is entered as Yes. If all four answers are no, the screen is complete and question 5 is not asked.
The NIMH toolkit is validated for patients aged 8 and over. For younger children, use a full mental health evaluation if you are concerned.
ASQ
Answer the questions to see the result.
This calculator adds up the score in your browser. Nothing you enter is stored or sent.
More about the ASQ
About the ASQWhat it is and what it is for
The ASQ is a four-question screen for suicide risk, developed at the National Institute of Mental Health for emergency departments, inpatient units and primary care. The first four questions are yes or no. A yes to any of them is a positive screen.
A positive screen gets one more question, asked right away: are you having thoughts of killing yourself right now? A yes marks an acute positive screen, which needs an urgent evaluation. A no marks a non-acute positive screen, which needs a brief suicide safety assessment before the person leaves.
How to use itGiving it and scoring it
Ask the four questions as written. Say them in the person's own language if you need to. If any answer is yes, or the person declines to answer, ask question 5. This page tells you which pathway the answers fall into.
Ask in private when you can, and for young patients, without the parent in the room if that is the local practice.
Interpreting the scoreScore ranges and what they suggest
The ASQ has no total score. The result is read from the answers.
| Answers | Result |
|---|---|
| No to questions 1 to 4 | Negative screenThe screen is complete. No intervention is needed from the screen. Clinical judgment can still override it. |
| Yes to any of questions 1 to 4, and no to question 5 | Non-acute positive screenPotential risk. A brief suicide safety assessment decides whether a full mental health evaluation is needed. The person should not leave until evaluated for safety. |
| Yes to any of questions 1 to 4, and yes to question 5 | Acute positive screenImminent risk. The person needs a STAT safety and full mental health evaluation, must not leave, and stays in sight. |
A person who declines to answer is treated as a positive screen. The yes to question 4 alone, an attempt in the past, is a positive screen.
Pearls and pitfallsTips and common mistakes
- A yes to any one of questions 1 to 4 is enough for a positive screen. Do not add the answers up.
- Ask question 5 every time the screen is positive, even when the only yes was a past attempt.
- Keep the person with a positive screen from leaving before the right level of evaluation is done.
- Make a plan before the person goes: a written safety plan, a conversation about lethal means, and crisis numbers.
- Use a fuller tool, such as the C-SSRS, to structure the assessment after a positive screen.
EvidenceAccuracy and reliability
- In the development study (Horowitz 2012), 524 patients aged 10 to 21 in three urban pediatric emergency departments were screened. The four-question version had a sensitivity of 96.9% and a specificity of 87.6% against a longer questionnaire.
- A later validation in adult medical inpatients (Horowitz 2020) supported its use across ages in hospital settings.
- The Joint Commission has recommended that medical patients in hospitals be screened for suicide risk, and NIMH reports that it has approved the ASQ for use at all ages.
- Accuracy depends on the population and what counts as an outcome. Studies in psychiatric emergency settings found high sensitivity and low specificity, which is the expected pattern for a screen.
Source, license and referencesWhere it comes from
The ASQ was developed at the National Institute of Mental Health (Horowitz, Bridge, Pao and colleagues). The NIMH toolkit describes it as a public domain tool, free of charge, available in many languages. Wording on this page follows the NIMH toolkit.
- Horowitz LM, Bridge JA, Teach SJ, et al. Ask Suicide-Screening Questions (ASQ): a brief instrument for the pediatric emergency department. Arch Pediatr Adolesc Med. 2012;166(12):1170-1176.
- Horowitz LM, Snyder DJ, Boudreaux ED, et al. Validation of the Ask Suicide-Screening Questions for adult medical inpatients: a brief tool for all ages. Psychosomatics. 2020. doi:10.1016/j.psym.2020.04.008.
- National Institute of Mental Health. Ask Suicide-Screening Questions (ASQ) Toolkit. nimh.nih.gov/asq.
- Stanley B, Brown GK. Safety Planning Intervention: a brief intervention to mitigate suicide risk. Cogn Behav Pract. 2012;19(2):256-264.