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Originally published October 9, 2025
Last updated October 9, 2025
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In recognition of World Mental Health Day in October, experts explain screening practices for suicide risk and depression at Keck Medicine of USC hospitals and clinics.
One in five U.S. adults experiences mental illness each year, with anxiety disorders and depressive diagnoses being the most prevalent. Having a mental illness, whether mild or acute, can make daily life more challenging not only for the individual but also the individual’s family, friends, coworkers and community. Health systems are uniquely positioned to identify risk early, often during routine encounters that seem unrelated to mental health.
Keck Medicine of USC psychiatrist Steven Siegel, MD, PhD, spoke with two Keck Medicine of USC nursing leaders — Gina Kucherepa, RN, associate administrator of evidence-based practice and nursing education, and Suzanne Small, RN, nursing director for USC Care — who explain why mental health screenings matter, how they work in practice and what patients and families of Keck Medicine can expect.
Kucherepa: In the hospital setting, suicide risk screening is part of whole-person care. There is more to each patient than what their presenting problem is. With suicide, we know that we cannot “see” risk through observation. We have to ask evidence-based questions. Having consistent screening reduces the risk of missing warning signs, especially in patients who are less likely to proactively share their struggle.
Small: I agree with Gina’s point about whole-person care. Sometimes patients have deeper psychological needs that are hidden in plain sight and not uncovered unless the patient is specifically asked and given an opportunity to disclose their mental health needs. That’s why at Keck Medicine, annual depression screening is part of routine primary care, family medicine and oncology appointments.
Kucherepa: At Keck Medicine hospitals, including Keck Hospital of USC, USC Norris Cancer Hospital, USC Arcadia Hospital and USC Verdugo Hills Hospital, patients are screened for suicide risk at intake sessions. At Keck Hospital of USC, USC Norris Cancer Hospital and USC Verdugo Hills Hospital, patients are screened using a tool called Ask Suicide–Screening Questions (ASQ). At USC Arcadia Hospital, the Columbia Suicide Severity Rating Scale (C-SSRS) is used. Both are brief, validated tools to identify suicide risk. If there is elevated risk, then a mental health professional, such as a social worker or psychiatrist, will evaluate the patient.
Small: In Keck Medicine’s family medicine, internal medicine and USC Norris Comprehensive Cancer Center clinics, patients annually complete a Patient Health Questionnaire-2 (PHQ-2) for depression screening. It comprises only two questions. If a screen shows risk for depression, then the patient is asked to complete the Patient Health Questionnaire-9 (PHQ-9), a short survey that gives patients and clinicians a better understanding of how depression may be showing up in a patient’s daily life.
This approach aligns with national standards, including U.S. Preventive Services Taskforce recommendations for adult depression screening, the Centers for Medicare & Medicaid Services’ annual quality measure and The Joint Commission’s requirements for identifying patients at risk.
Kucherepa: If a patient’s screens in the hospital signal acute risk, immediate safety measures are taken. The patient’s primary care provider assesses the patient, then specialists like consultation-liaison psychiatry or a crisis specialist social worker are consulted right away.
Small: In outpatient locations, the PHQ-9 score shows the depression severity, and the provider will use that and clinical assessment of the patient to address the patients’ symptoms and to create an appropriate care plan.
If suicide risk is identified, further assessment occurs by the care team and/or a social worker to better identify risk severity and to connect the patient to the right care.
In rare cases where the patient is experiencing an active psychiatric emergency, then safety measures are implemented while other professionals are brought in to support.
Kucherepa: Tools like the ASQ, mentioned earlier, are short and straightforward, making them easy to integrate into an intake session without disrupting other acute care needs.
Small: In primary care clinics, screening is tied to an annual visit, so it becomes a routine part of preventive care without adding extra appointments.
Small: I completely understand that for some patients, these questions may feel uncomfortable or unfamiliar. Our role as nurses is to create a safe, nonjudgmental space so patients know they are not being singled out. The more we as nurses are comfortable asking the questions, the more we can make the patient comfortable. We can normalize the conversation by explaining that these questions are part of whole-person care, just like taking blood pressure is. When patients see that we ask everyone these questions, it reinforces the message that mental health is an important part of overall health for everyone.
Kucherepa: Building on what Suzanne said, when we ask about suicide in the hospitals, some patients are initially surprised, especially if they’ve never been asked about it before. What often helps is explaining why we ask: suicide is a serious health risk, and talking about it openly can save lives. Once patients understand that the questions are about safety and support, not judgement, many actually express relief that we brought it up. Nurses help them open a door that may have seemed too heavy to open on their own.
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