(PS9-47) Beyond Translations: Cultural Adaptation of the Ask Suicide-screening Questions (ASQ) Tool in Global Healthcare Settings

Introduction: Suicide is a global public health crisis, with more than 700,000 people dying by suicide every year. Of note, 77% of suicides occur in low- and middle-income countries where awareness/resources for suicide prevention are scarce. Prior studies have found that most people who die by suicide have contact with a healthcare provider weeks prior to their death, underscoring the importance of suicide risk screening in medical settings. To support this goal, healthcare providers need validated suicide risk screening tools. The Ask Suicide-Screening Questions (ASQ) is a brief suicide risk screening tool validated for use in various medical settings. It was developed in English and has excellent psychometric properties. It has been translated into 23 languages and validated in countries where English is not the primary language. Important cultural considerations about the interpretation of the translated tool were uncovered. This poster will describe the process of translating and culturally adapting the ASQ in three languages and countries.

Methods: Examples from international ASQ validation studies in Pakistan (Urdu), Ethiopia (Amharic), and Hungary (Hungarian) will be presented. To ensure that the translated versions of the ASQ are culturally responsive, clinicians from countries where the language of interest is primarily spoken collaborated with the ASQ research team. The clinicians directly translated the ASQ into their language and back translated their version into English. Lastly, the direct translations were either modified based on clinical judgement or tested through pilot research by the local teams before being used in the validation studies.

Results: Direct translations of the ASQ required modifications to retain the meaning of the original items. In a pilot study with 25 adult Urdu-speaking patients, concerns were raised about the direct translation of the first ASQ question. The use of the word “wish” did not convey the correct intent in Urdu and asking about being “dead” was off-putting due to stigma around suicide in Pakistan. Therefore, to accommodate the cultural connotation and context in Urdu, the first question was modified. Similarly, a pilot study with 73 adult Hungarian-speaking patients was conducted to test the fifth ASQ question that inquires about the acuity of suicidal thoughts. They tested the word “thought” in the fifth question and added an alternative question using the word “intention.” It was found that the original question with the word “thought” was sufficient in capturing acuity, with a Cronbach alpha of .71. Lastly, the Amharic ASQ was modified by Amharic-speaking clinicians by adding the words “not alive” to ask about suicide risk in a culturally sensitive manner. These modifications in Urdu and Amharic were then validated by research and demonstrated strong psychometric properties. The Hungarian validation study is underway.

Conclusion: Suicide risk screening tools give healthcare providers an opportunity to start important conversations about suicide. With limited evidence-based tools available for non-English speaking patients/clinicians, translating and validating culturally appropriate tools is critical for suicide prevention efforts in healthcare settings worldwide.