Suicide risk can be difficult to recognize from appearance, mood, or the reason someone came to a clinic or emergency department. Some people who are having suicidal thoughts do not volunteer that information unless they are asked directly, privately, and in a way that feels routine rather than alarming.
The ASQ is a brief suicide risk screening tool designed to help health professionals identify people who may need a more detailed safety assessment. It is not a diagnosis, and it does not predict the future with certainty. Its purpose is narrower and practical: to quickly flag possible suicide risk so that the right follow-up questions, safety steps, and care decisions can happen without delay.
Table of Contents
- What ASQ Suicide Screening Measures
- When ASQ Screening Is Used
- How the ASQ Is Given
- What ASQ Results Mean
- What Happens After a Positive Screen
- Accuracy, Strengths, and Limits
- ASQ vs Other Suicide Risk Tools
- What Patients and Families Should Know
What ASQ Suicide Screening Measures
The ASQ screens for recent suicidal thoughts and past suicide attempts using a small set of direct yes-or-no questions. It is designed to detect possible risk, not to label someone, determine intent on its own, or replace a full clinical evaluation.
ASQ stands for Ask Suicide-Screening Questions. The standard tool asks about several related but distinct signs of suicide risk: wishing to be dead, feeling that others would be better off if the person were dead, recent thoughts of killing oneself, and any past suicide attempt. If any of those questions are answered “yes,” the person is asked an additional acuity question about whether they are having thoughts of killing themselves right now.
That structure matters because suicide risk is not one single thing. A person may have passive thoughts of death but no current intent. Another person may deny current suicidal thoughts but have a past suicide attempt that still needs careful context. Someone else may have current suicidal thoughts that require immediate safety action. The ASQ is built to separate a negative screen, a non-acute positive screen, and an acute positive screen so that staff know what kind of next step is needed.
The ASQ is part of the broader category of suicide risk screening. Screening means using a brief, standardized set of questions to decide whether more evaluation is needed. That is different from diagnosis. A suicide screen does not diagnose depression, bipolar disorder, trauma-related symptoms, substance use disorder, or any other mental health condition. It also does not determine whether someone will or will not attempt suicide later.
The ASQ is also different from a general mood questionnaire. Depression is an important suicide risk factor, but suicide risk can occur in people who do not meet criteria for major depression or who do not endorse depression symptoms on a general screen. For that reason, many medical settings use suicide-specific questions rather than relying only on depression screening.
The main information the ASQ provides is practical: whether the person’s answers suggest no identified risk at that moment, possible risk that needs a brief suicide safety assessment, or acute risk that needs urgent safety evaluation before the person leaves the setting.
When ASQ Screening Is Used
The ASQ is most often used in medical and clinical settings where a quick, validated suicide risk screen is needed. It may be used routinely for many patients or selectively when symptoms, circumstances, or clinical concerns raise the possibility of suicide risk.
Common settings include emergency departments, inpatient medical or surgical units, primary care offices, outpatient specialty clinics, and some behavioral health workflows. The tool was developed for medical settings, which is important because many people at risk for suicide are seen for physical symptoms, injuries, pain, chronic illness, sleep problems, substance-related concerns, or routine care rather than for a stated mental health crisis.
In pediatric care, age and development matter. Youth age 12 and older are often screened routinely when they are medically and developmentally able to answer. Children ages 8 to 11 may be screened when clinically indicated, such as when there is a behavioral health concern, a history of suicidal thoughts or behavior, concerning statements, severe distress, self-harm, or a parent or clinician concern. For children under 8, formal screening is generally not the usual approach; if warning signs are present, clinicians typically move directly to a developmentally appropriate mental health evaluation.
Adults may also be screened with ASQ-based workflows in medical settings. In adults, suicide risk screening may be used during hospitalization, in emergency care, in primary care, or in specialty clinics when health systems have implemented a standard pathway. This can be especially relevant when a person has severe pain, serious illness, substance use concerns, major life stress, agitation, hopelessness, recent loss, or other factors that may increase risk.
ASQ screening may also be used alongside other mental health screening tools. For example, a primary care office may screen for depression, anxiety, substance use, and suicide risk during the same visit, depending on the patient’s age, symptoms, and clinic policy. A broader primary care mental health screening process may identify concerns that then require a focused suicide safety assessment.
Screening is not limited to people who “look suicidal.” That is one of the reasons standardized tools exist. Risk can be missed when clinicians rely only on appearance, diagnosis, family reports, or the patient’s chief complaint. A calm person can be at risk. A person seen for a medical problem can be at risk. A person with no obvious depression symptoms can still have suicidal thoughts.
At the same time, the ASQ should not be used casually without a response plan. Any setting that screens for suicide risk needs a clear procedure for what happens if someone screens positive, who performs the follow-up assessment, how urgent risk is handled, how privacy is protected, and how families or caregivers are involved when appropriate.
How the ASQ Is Given
The ASQ is usually given as a brief spoken or written set of questions by a trained staff member. It is designed to be quick, but the setting, privacy, and response to the answers are just as important as the questions themselves.
In many clinics and hospitals, a nurse, medical assistant, social worker, physician, psychologist, or other trained team member asks the questions during intake or triage. The questions are direct because vague wording can miss risk. A clinician might introduce the screen by saying that these questions are asked of many patients because emotional distress and thoughts of suicide are common enough that health systems take them seriously.
The standard ASQ asks about:
- Wishing to be dead in the past few weeks.
- Feeling that the person or their family would be better off if the person were dead.
- Thoughts of killing oneself in the past week.
- Any past suicide attempt.
- Current thoughts of killing oneself, if any of the first four questions are answered “yes.”
For youth, privacy is especially important. When possible, clinicians often ask parents, guardians, siblings, friends, and other visitors to step out briefly so the young person can answer honestly. This is not meant to exclude caregivers from care. It helps create a safe space for disclosure, especially when a young person is afraid of upsetting someone, getting in trouble, or being judged. If a parent or guardian must remain present for developmental, medical, or practical reasons, the clinician may still proceed while recognizing that answers may be affected by who is in the room.
The ASQ can also be administered by tablet, paper form, or electronic health record workflow. Electronic administration can feel less intimidating for some people, but it does not remove the need for human follow-up. A “yes” answer is not just data in a chart; it is a signal that someone should check in, clarify the level of risk, and decide what safety steps are needed.
A careful screener also pays attention to the patient’s ability to participate. Severe confusion, intoxication, delirium, psychosis, language barriers, acute medical instability, or developmental limitations can make a standard screen unreliable. In those situations, clinicians may delay screening, use an interpreter, involve a specialist, gather collateral information, or proceed directly to a clinical safety assessment.
The way the questions are asked should be calm and matter-of-fact. Asking about suicide does not have to sound dramatic. A steady tone helps communicate that the topic is serious but discussable, and that answering honestly is a path to help rather than punishment.
What ASQ Results Mean
ASQ results sort the screen into broad risk-response categories. A result should guide the next step, not be treated as a complete explanation of the person’s mental state.
| ASQ result | Typical meaning | Usual next step |
|---|---|---|
| Negative screen | The person answered “no” to the initial suicide risk questions. | No suicide-specific intervention may be needed at that moment, unless clinical judgment suggests otherwise. |
| Non-acute positive screen | The person answered “yes” to one or more initial questions but “no” to current thoughts of killing themselves. | A brief suicide safety assessment is usually needed to clarify risk and decide whether further evaluation is needed. |
| Acute positive screen | The person endorsed current thoughts of killing themselves. | Urgent safety evaluation is needed, and the person should not leave before safety is assessed. |
| Refusal or unable to answer | The screen may be incomplete or unreliable. | Clinicians use judgment, context, and setting-specific policy to decide whether assessment or safety steps are needed. |
A negative screen is reassuring only within limits. It means the person did not endorse the ASQ risk items at that time. It does not prove that suicide risk is impossible, and it does not override concerning clinical signs such as severe agitation, intoxication, psychosis, recent self-harm, threatening behavior, or credible reports from family members.
A non-acute positive screen means potential risk has been identified, but not necessarily immediate danger. For example, a person might report a past suicide attempt years ago but deny current suicidal thoughts. Another person might report recent passive death wishes without a plan or intent. These answers still matter because they may point to distress, past vulnerability, or current need for support.
An acute positive screen is more urgent because it involves current thoughts of killing oneself. This does not automatically mean the person will be hospitalized, but it does mean the person needs immediate attention from a clinician who can assess safety, intent, plan, access to lethal means, protective factors, supports, and the safest disposition.
This is why the difference between mental health screening and diagnosis is important. The ASQ result is not the final clinical answer. It is the doorway into the next level of evaluation.
What Happens After a Positive Screen
A positive ASQ screen should lead to a brief suicide safety assessment, urgent evaluation, or another safety-focused next step depending on acuity. The goal is to understand immediate risk and connect the person with the right level of care.
For many non-acute positive screens, the next step is a brief suicide safety assessment. This is more detailed than the ASQ but still focused. It may take about 10 to 15 minutes in many clinical workflows, though the time can vary. The clinician may ask about the frequency and intensity of suicidal thoughts, whether there is a plan, whether the person has intent to act, access to firearms or other lethal means, past attempts, recent losses, substance use, agitation, protective relationships, reasons for living, and what support is available after the visit.
The assessment may also include a safety plan. A safety plan is not just a promise not to attempt suicide. It is usually a concrete, written or shared plan that identifies warning signs, coping steps, people to contact, professional resources, crisis options, and ways to reduce access to lethal means. For youth, caregivers are often involved in practical safety planning, including supervision and securing medications, firearms, sharp objects, ligatures, or other dangerous items as clinically appropriate.
If the person screens acute positive, the response is more immediate. The person should remain under observation according to the setting’s policy, dangerous objects should be removed when feasible, and a qualified clinician should evaluate the person before they leave. In an emergency department or hospital, this may involve a mental health professional, physician, crisis team, or psychiatric consultation. In an outpatient clinic, it may involve keeping the person in the clinic while arranging emergency evaluation or crisis support.
A positive screen does not always mean psychiatric admission. Some people can be safely managed with outpatient follow-up, family support, a safety plan, medication review, therapy referral, crisis services, or close monitoring. Others need a higher level of care, such as emergency evaluation, intensive outpatient treatment, partial hospitalization, inpatient psychiatric care, or medical stabilization if there has been self-harm, overdose, intoxication, delirium, or another urgent condition.
After any positive mental health screen, patients and families often want to know what the result means for privacy, treatment, and daily life. A broader explanation of what happens after a positive mental health screen can help frame the process: the screen is the beginning of a clinical conversation, not the end of one.
Accuracy, Strengths, and Limits
The ASQ’s main strength is that it is brief, direct, and validated in several medical populations. Its main limit is that no screening tool can determine suicide risk with certainty or replace clinical judgment.
In the original pediatric emergency department validation work, a “yes” response to one or more ASQ questions identified a high proportion of youth at elevated suicide risk. Later studies supported its use in other settings, including pediatric medical and surgical inpatients, outpatient youth clinics, and adult medical inpatients. This makes the ASQ useful for busy medical environments where staff need a short, standardized way to identify who needs more evaluation.
High sensitivity is especially important in suicide risk screening. A screening tool should be designed to miss as few at-risk people as possible, even if that means some people screen positive and later turn out not to need intensive intervention. In practice, that means a positive ASQ result is not a diagnosis or a prediction. It is a safety signal.
False positives can happen. Someone may endorse a past attempt from many years ago and have no current suicidal thoughts. A patient may answer “yes” to a passive death-wish question during a period of pain, grief, or exhaustion without having intent or a plan. These answers still deserve respectful follow-up, but they do not all mean the same level of risk.
False negatives can also happen. A person may deny suicidal thoughts because of fear, shame, confusion, mistrust, cultural concerns, worry about hospitalization, or the presence of family members. Others may have rapidly changing risk that was not present at the moment of screening. This is why clinical judgment can override a negative screen when the situation is concerning.
The ASQ also has boundaries. It is not designed to measure the full severity of depression, anxiety, trauma, psychosis, substance use, personality patterns, or neurocognitive impairment. It does not replace depression screening, substance use assessment, trauma assessment, or a full psychiatric evaluation when those are indicated.
Language and culture matter as well. A translated tool should be more than word-for-word accurate; it should make sense in the patient’s language and cultural context. Clinicians should use trained interpreters when needed and avoid relying on family members to interpret suicide risk questions, especially for children and teens.
The safest way to understand ASQ accuracy is to view it as one part of a pathway. A good pathway includes screening, follow-up assessment, clinical judgment, safety planning, documentation, family or caregiver involvement when appropriate, and a clear plan for urgent care when risk is acute.
ASQ vs Other Suicide Risk Tools
The ASQ is a brief suicide risk screen, while some other tools are broader, more detailed, or designed for different points in the assessment process. The best tool depends on the setting, the patient population, and what decision needs to be made.
The Columbia-Suicide Severity Rating Scale, often called the C-SSRS, is one of the most widely known suicide risk assessment tools. It can ask in more detail about suicidal ideation, behavior, intent, preparatory actions, and severity. In some settings, the C-SSRS is used for triage, risk stratification, research, or follow-up after an initial positive screen. A focused explanation of the C-SSRS suicide risk assessment can be helpful when comparing brief screening with more detailed risk assessment.
The PHQ-9, a common depression questionnaire, includes an item about thoughts of being better off dead or self-harm. That item is clinically important, but it is not the same as a suicide-specific screen. Some people at suicide risk do not screen positive for depression. Others may endorse depression symptoms but not disclose suicidal thoughts on a single broad item. Many clinics therefore pair depression screening with a suicide-specific tool rather than assuming one can replace the other.
The ASQ is often favored when the goal is fast identification in a medical workflow. It takes very little time, uses plain yes-or-no questions, and has clear next-step categories. It can be easier to build into triage, inpatient nursing workflows, or primary care intake than a longer assessment tool.
More detailed tools are often useful after risk has been identified. A clinician may begin with ASQ, then use a brief suicide safety assessment, C-SSRS, psychiatric interview, safety planning intervention, or crisis evaluation depending on the result. In that sense, ASQ is not competing with every other tool. It often sits at the first step of a tiered process.
No tool should be chosen only because it is convenient. A clinic or hospital should consider whether the tool has been validated for the age group and setting, whether staff are trained to use it, whether it is available in the patient’s language, whether the electronic health record supports the workflow, and whether there is a clear response plan for positive screens.
The most important comparison is not ASQ versus another named tool. It is screening without a pathway versus screening with a pathway. A brief tool becomes clinically useful only when a positive answer leads to timely assessment, safety steps, and follow-up care.
What Patients and Families Should Know
Patients and families should know that ASQ screening is meant to open a safe conversation, not to punish honesty. The most helpful response is to answer as directly as possible and ask what the next step means.
For patients, a few points are especially important. First, saying “yes” does not automatically mean hospitalization. It means the care team needs to ask more questions to understand how serious and immediate the risk is. Second, it is okay to describe nuance. A person can say, “I have wished I would not wake up, but I do not want to kill myself,” or “I had thoughts last week, but not today,” or “I attempted suicide years ago and have not felt that way recently.” Those details matter.
Third, the clinician may ask practical questions that feel personal: whether there is a plan, whether there is access to firearms or medications, whether substances are involved, and who can help at home. These questions are not meant to accuse the patient. They help the clinician reduce danger while the person is under stress.
For parents and caregivers, it can be frightening to learn that a child or teen screened positive. The first response should be calm listening rather than interrogation or punishment. Young people may shut down if they believe honesty will only lead to anger, shame, or loss of trust. Caregivers can still take the result seriously while saying, in effect, “I’m glad you told someone. We are going to help you stay safe.”
Families should also understand that privacy and safety are both part of care. A teen may be screened privately, but caregivers are usually involved when there is safety risk. The goal is not secrecy; it is to help the young person speak openly and then build a safe plan with the right people involved.
Immediate help is needed if someone has current suicidal thoughts with intent, a plan, access to lethal means, recent self-harm, an overdose, severe agitation, intoxication, psychosis, or cannot agree to stay safe long enough to be evaluated. In those situations, call emergency services, go to the nearest emergency department, contact a local crisis team, or call or text 988 in the United States. Do not leave the person alone while urgent risk is present.
For more general warning signs and emergency decision-making, information on when to seek emergency care for mental health symptoms can help families distinguish routine follow-up from immediate danger. When in doubt, it is safer to involve a clinician or crisis service than to wait and hope the risk passes.
References
- Ask Suicide-Screening Questions (ASQ) Toolkit. 2025 (Toolkit)
- Ask Suicide-Screening Questions (ASQ) Suicide Risk Screening Tool. 2025 (Tool)
- Screening for Suicide Risk in Clinical Practice. 2023 (Clinical Guidance)
- Screening and Assessing Suicide Risk in Medical Settings: Feasible Strategies for Early Detection. 2023 (Review)
- Ask Suicide-Screening Questions (ASQ): A Brief Instrument for the Pediatric Emergency Department. 2012 (Validation Study)
- Validation of the Ask Suicide-Screening Questions (ASQ) for Adult Medical Inpatients: A Brief Tool for All Ages. 2020 (Validation Study)
Disclaimer
This information is for general educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Suicide risk can change quickly; if you or someone else may be in immediate danger, contact emergency services, a crisis line, or a qualified clinician right away.
If this article was helpful, consider sharing it on Facebook, X, or your preferred platform so others can better understand how suicide risk screening works.
