Psychometric Evidence of Suicide Risk Assessment Tools for Children and Adolescents: A Systematic Review

Numerous suicide risk assessment tools exist, but their psychometric quality, diagnostic accuracy and cultural applicability for youth are unclear. This review aims to synthesise the evidence on the psychometric performance and clinical feasibility of suicide risk assessment instruments for children and adolescents. A systematic review was conducted in accordance with the Cochrane Handbook and reported following the PRISMA 2020 guidelines and was prospectively registered in PROSPERO (CRD42024569168). Seven databases were searched from inception to July 2024, without language restrictions, for observational studies evaluating psychometric or diagnostic properties of suicide risk instruments in populations aged <19 years. Methodological quality was assessed using the Law–MacDermid tool and Roy’s criteria. Fifty included studies ( n = 36,966 participants) evaluated 11 instruments. The Ask Suicide-Screening Questions (ASQ) and Suicide Behaviours Questionnaire-Revised (SBQ-R) demonstrated the strongest evidence, with high internal consistency and excellent diagnostic accuracy (area under the curve [AUC] > .90) across emergency, inpatient, outpatient and primary-care settings. ASQ and SBQ-R currently provide the most robust evidence for brief suicide risk assessment in children and adolescents. Integrating these validated tools into routine nursing, school, and primary-care practice may strengthen early identification and referral pathways. These findings support global mental health priorities, including Sustainable Development Goals (SDGs).