In recent years, the global mental health community has increasingly recognized the urgent need for effective suicide prevention strategies, particularly among vulnerable youth populations. Nepal, a nation grappling with one of the highest suicide rates among young people worldwide, faces unique challenges in this realm. A groundbreaking study now sheds light on a crucial step forward: the validation of a suicide risk screening tool adapted specifically for the Nepali medical inpatient youth demographic. This development promises to revolutionize how healthcare providers identify and manage suicide risk within hospital settings, potentially saving countless lives.
Suicide remains a leading cause of death among adolescents and young adults globally, with significant social and economic consequences. In Nepal, cultural stigma, limited mental health resources, and linguistic barriers compound the difficulties in implementing effective psychiatric screening and intervention. Traditional screening instruments, while validated in Western contexts, often fail to translate seamlessly across cultures and languages. This gap has historically hindered early detection of suicidal ideation or behaviors during medical hospitalization, a premium time for clinical intervention.
Responding to this critical void, researchers conducted a comprehensive cross-sectional validation study focusing on the Nepali adaptation of the Ask Suicide-Screening Questions (ASQ) tool. The ASQ, originally developed by the National Institute of Mental Health, is prized for its brevity and efficacy in detecting suicide risk. However, prior to this study, its utility among Nepali-speaking inpatient youth remained untested, limiting its clinical applicability in the region. The investigative team sought not only to adapt the tool linguistically but also to rigorously evaluate its psychometric properties against established clinical benchmarks.
The study enrolled 309 participants aged between 10 and 24 years from two major urban hospitals in Nepal, ensuring a representative sample of medical inpatients. These individuals underwent screening by trained nursing personnel employing the newly translated ASQ questionnaire. Importantly, the participants also completed the adolescent version of the Patient Health Questionnaire-9 (PHQ-9), a recognized instrument to assess depression severity known to correlate with suicidal ideation. This multi-layered approach allowed for a nuanced understanding of mental health status alongside suicidal risk detection.
Central to validating the ASQ’s accuracy was the use of a blind brief suicide safety assessment (BSSA) conducted by clinical psychologists. The BSSA served as the gold standard comparator, providing an objective framework to evaluate the screening tool’s sensitivity and specificity. By employing experts who were not influenced by ASQ results, the study minimized bias and strengthened the robustness of its findings.
The results revealed that 15.9% of participants screened positive for suicide risk using the ASQ, while 8.4% were identified as having elevated suicide risk via the BSSA. Crucially, the ASQ demonstrated commendable diagnostic performance: a sensitivity rate of 77%, suggesting a strong ability to correctly identify individuals at risk, and a specificity rate of 90%, indicating effectiveness in correctly excluding those not at risk. The positive predictive value stood at 41%, reflecting the proportion of true positives among those flagged by the ASQ, and the negative predictive value was notably high at 98%, underscoring the tool’s reliability in ruling out suicide risk.
These psychometric indicators affirm that the Nepali ASQ is both a valid and efficient instrument for suicide risk screening in hospitalized youth populations. Its brevity ensures that it can be feasibly integrated into routine clinical workflows without causing significant additional burden on healthcare staff. Moreover, early identification facilitated by such a tool could lead to timely referrals and interventions, potentially reducing suicide rates in this at-risk group.
Beyond validation, the study’s context highlights important implications for healthcare policy and practice in Nepal. Incorporating culturally adapted, linguistically appropriate screening methods addresses long-standing barriers in mental health care delivery. The integration of such tools during hospitalization—when patients are already engaged with healthcare systems—represents a practical touchpoint to bridge detection and treatment, especially in low-resource environments where psychiatric services are scarce.
Importantly, the researchers advocate for broader implementation and further validation in diverse settings, including outpatient clinics and community health centers. Extending the utility of the Nepali ASQ could facilitate comprehensive surveillance of suicide risk across multiple healthcare touchpoints, advancing public health surveillance and preventive care frameworks.
The study also underscores the vital role that trained nursing personnel and mental health professionals play within multidisciplinary teams. Effective suicide screening hinges on skilled administration, sensitive communication, and appropriate follow-up actions. Capacity-building initiatives aimed at equipping frontline healthcare workers with necessary tools and knowledge are therefore essential components of systemic suicide prevention strategies.
While the ASQ’s validation marks a significant advancement, mental health stakeholders recognize the necessity for ongoing research and refinement. Factors such as cultural perceptions of suicide, stigma, and family dynamics must be considered when interpreting screening outcomes and designing subsequent interventions. Combining quantitative screening tools with qualitative assessments could yield more comprehensive understandings of risk profiles.
This innovative research represents a paradigm shift in suicide prevention efforts within Nepal. By providing a scientifically validated, culturally tailored screening mechanism, it empowers healthcare professionals to better identify vulnerable youth and implement critical interventions during hospital stays. The potential ripple effects extend beyond individual patients to families and communities, fostering resilience and hope in the face of a daunting mental health challenge.
As the global community rallies to meet the United Nations Sustainable Development Goals on health and well-being, projects like the Nepali ASQ validation exemplify the synergy between research, clinical practice, and public health policy. Continued investment in such culturally sensitive tools and their implementation could herald a new era in reducing youth suicide rates in Nepal and similar contexts worldwide.
Looking ahead, researchers emphasize that integrating suicide screening tools with expanded mental health services—such as counseling, crisis intervention, and follow-up care—will be critical. Building infrastructure that supports these interventions requires collaboration across government agencies, healthcare institutions, non-governmental organizations, and community leaders. Embracing a holistic, patient-centered approach stands as the cornerstone of effective suicide prevention.
In summary, the validation of the Nepali version of the Ask Suicide-Screening Questions tool offers a robust, evidence-based foundation to enhance suicide risk assessment among medical inpatients aged 10 to 24 years in Nepal. This pioneering work not only addresses a previously unmet clinical need but also paves the way for systemic changes in mental health screening and intervention. As Nepal and the wider global health community continue to battle the tragic consequences of youth suicide, such innovations provide much-needed tools to save lives and nurture futures.
Subject of Research: Validation of the Nepali version of the Ask Suicide-Screening Questions (ASQ) tool for suicide risk detection among youth medical inpatients.
Article Title: Validity of the Nepali Ask Suicide Screening Questions tool for medical inpatients
Article References:
Poudel, D.R., Sharma, A.K., Chapagain, R.H. et al. Validity of the Nepali Ask Suicide Screening Questions tool for medical inpatients. BMC Psychiatry 25, 719 (2025). https://doi.org/10.1186/s12888-025-07148-w
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