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. 2025 Jul 22;25(1):719.
doi: 10.1186/s12888-025-07148-w.

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

Daman R Poudel  1 , Arun K Sharma  2   3 , Ram H Chapagain  4   5 , Manisha Chapagai  6 , Nathan J Lowry  7 , Mahesh R Sigdel  6 , Krishna P Bista  5 , Rahul Pathak  6 , Arun Kunwar  4 , Janna Patterson  8 , Terrell Carter  8 , Lisa M Horowitz  7
Affiliations

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

Daman R Poudel et al. BMC Psychiatry. .

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.

Keywords: Ask Suicide-Screening questions; Mental health; Nepal; Suicide; Validation; Youth.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Informed consent was taken from all participants prior to data collection. Participants were provided with information regarding the purpose of the study, the voluntary nature of the participation, confidentiality of their responses and their right to withdraw at any time without any consequences. The study was approved by ethics committees of Nepal Health Research council [261–2021], Institute of Medicine (Tribhuvan University– IRC,436(6–11) E2 077/078) and Kanti Children’s Hospital (KCH– IRC,1181) as well as the American Academy of Pediatrics IRB (21 PA 01) and all study procedures were completed by full adherence to ethical guidelines and regulations as per Declaration of Helsinki. Consent for publication: Not Applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Study profile
Fig. 2
Fig. 2
ROC curve illustrating agreement between ASQ and BSSA Predictive ability of Nepali version of ASQ for suicide risk was compared to BSSA as the gold standard after controlling for covariates age and gender. Diagonal represents ties
See this image and copyright information in PMC

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