Vasa Roma A, Kalari Vamsi K, Kitchen Christopher A, Kharrazi Hadi, Campo John V, Wilcox Holly C
Jt Comm J Qual Patient Saf. 2025 Mar;51(3):192-198. doi: 10.1016/j.jcjq.2024.11.002. Epub 2024 Nov 8.
Youth with autism spectrum disorder (ASD) are over three times more likely to experience suicidal thoughts and behaviors (STB) than children in the general population. Screening to detect suicide risk is therefore critical for youth with ASD. This study examines the capacity of the Ask Suicide-Screening Questions (ASQ), a standard suicide screening tool, to detect suicide risk in children and adolescents with ASD who present to the pediatric emergency department (PED).
This is a retrospective chart review of 393 (2.1%) youth with ASD and 17,964 (97.9%) youth without ASD, aged 8 to 21 years, who presented to the PED of a large urban academic medical center between 2017 and 2020. During the study period, the ASQ was universally administered to children and adolescents who presented to the PED for any reason. Data extracted from the electronic health record included demographic information, presenting concerns, ASD diagnosis, and ASQ results.
Autistic children and adolescents were more likely to present to the PED with STB at the first PED visit compared to non-autistic children (12.7% vs. 4.4%, p < 0.001). In both autistic and non-autistic groups, presenting concerns about STB were significantly associated with a positive ASQ screen. More autistic youth were found to have a positive ASQ without STB as their chief presenting complaint as compared to non-autistic youth (22.6% vs. 11.6%, p < 0.001). Youth with ASD endorsed each item of the ASQ at roughly twice the rate of those without ASD.
This preliminary descriptive study indicates that the ASQ may be a promising screening tool to assess suicide risk in autistic individuals. Further research on the predictive validity and overall reliability of the ASQ in youth with ASD is recommended.
患有自闭症谱系障碍（ASD）的青少年出现自杀念头和行为（STB）的可能性是普通人群中儿童的三倍多。因此，对患有ASD的青少年进行自杀风险筛查至关重要。本研究考察了标准自杀筛查工具“自杀筛查问题（ASQ）”检测前往儿科急诊科（PED）就诊的患有ASD的儿童和青少年自杀风险的能力。
这是一项对393名（2.1%）患有ASD的青少年和17964名（97.9%）未患ASD的青少年进行的回顾性病历审查，这些青少年年龄在8至21岁之间，于2017年至2020年期间前往一家大型城市学术医疗中心的儿科急诊科就诊。在研究期间，ASQ被普遍应用于因任何原因前往儿科急诊科就诊的儿童和青少年。从电子健康记录中提取的数据包括人口统计学信息、就诊问题、ASD诊断以及ASQ结果。
与非自闭症儿童相比，自闭症儿童和青少年在首次前往儿科急诊科就诊时更有可能出现自杀念头和行为（12.7%对4.4%，p<0.001）。在自闭症和非自闭症组中，对自杀念头和行为的就诊问题与ASQ筛查呈阳性显著相关。与非自闭症青少年相比，更多自闭症青少年的ASQ呈阳性，但自杀念头和行为并非其主要就诊主诉（22.6%对11.6%，p<0.001）。患有ASD的青少年对ASQ各项目的认可率约为未患ASD青少年的两倍。
这项初步描述性研究表明，ASQ可能是评估自闭症个体自杀风险的一种有前景的筛查工具。建议对ASQ在患有ASD的青少年中的预测效度和整体可靠性进行进一步研究。
