In Reply Wintersteen et al suggest that the results of the Ask Suicide-Screening Questions (ASQ) study1 should be interpreted with caution because the Suicidal Ideation Questionnaire (SIQ)2 was used as the criterion standard. We respectfully disagree. The SIQ was designed to be administered, scored, and interpreted by mental health clinicians. Subjects are asked to give their best estimate of how often during the past month they had 30 different types of thoughts, ranging from “never” to “almost every day.” If subjects score above a threshold, they are considered to have clinically significant suicidal ideation. By contrast, the ASQ was developed as a screening tool for non–mental health clinicians to help them detect suicidal ideation and past suicide attempts in young people. Use of the ASQ is not meant to replace a diagnostic assessment. From a statistical standpoint, the fact that 3 items selected for the ASQ were similar on the 2 instruments and were the ones most highly correlated with a positive SIQ score is to be expected and, moreover, reinforces that the candidate questions are measuring what we want them to—clinically significant suicidal ideation that may indicate suicidal risk and therefore warrants further evaluation from a trained mental health professional.
Horowitz LM, Bridge JA, Pao M. What Is Meant by “Increased Risk for Suicide”?—Reply. JAMA Pediatr. 2013;167(7):676. doi:10.1001/jamapediatrics.2013.149