Date of Award

January 2024

Document Type

Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Ashley Hagaman

Abstract

Objectives: Suicide is a severe public health crisis around the globe. Low-middle-income countries (LMICs) bear 77% of the global suicide burden. Screening is a significant component of suicide prevention, but there is a dearth of suicide screening tools, especially in LMICs. This study focused on validating the Ask Suicide-Screening Questions (ASQ) within an adult Emergency Department (ED) population in Nepal. Although the validation occurred in an ED setting, the Nepali ASQ is designed with the flexibility to be useful in a variety of healthcare contexts, extending its applicability beyond just emergency care.Methods: We systematically translated and adapted the 4-item ASQ, and ultimately created the 5-item Nepali ASQ. A cross-sectional validation study was conducted involving adult patients who were proficient in the Nepali language, agreed to answer screening questions, and had inappropriate health and cognitive states deemed by clinical staff. Convenience sampling was utilized to recruit participants. The Nepali ASQ tool was validated against the Beck Scale for Suicide Ideation as the criterion standard, and the Patient Health Questionnaires as another benchmark. Results: Among1130 ED patients, 147 adults consented to enroll in Nepali ASQ validation. Among them, 11.56% screened positive for suicidal ideation: 8.84% reported passive and 4.08% active ideation. The breakdown by gender showed 10.94% of 64 males and 12.05% of 83 females screened positive. The Nepali ASQ's performance included a sensitivity of 95.4% and a specificity of 68.8%, with PPVs and NPVs of 96.2% and 64.7%, respectively. The diagnostic accuracy was supported by an LR+ of 3.053, LR- of 0.067, a Cohen’s kappa of 0.625, and an AUC of 0.821, indicating substantial agreement and strong discriminative ability. Conclusions: The Nepali ASQ is a culturally adapted and valid instrument for identifying suicide risk in Nepali adults. It shows promise for effectively detecting individuals at elevated risk for suicide, thus supporting its use in hospital settings in Nepal.

Comments

This thesis is restricted to Yale network users only. It will be made publicly available on 05/07/2026

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