Study Supports Efficacy of 9-Item Depression Screening in Identifying Patients at Risk for Suicide

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October 5 is National Depression Screening Day. A recent study that compared the effectiveness of suicide screening and several types of depression screenings supported the efficacy of the 9-item Patient Health Questionnaire (PHQ-9) in comparison to other screening tools. However, the study investigators also concluded that depression screening alone may not be sufficient to effectively identify suicide risk.

The study, conducted by researchers at the Ohio State University Wexner Medical Center and Wesleyan University, compared the effectiveness of suicide risk screening and depression screening alone among primary care patients. The study included 2744 patients between the ages of 18 and 89 years from 6 primary care clinics who completed several depression screenings—including the self-administered PHQ-9 and the 2-item Patient Health Questionnaire (PHQ-2)—and the suicidal ideation (SI) screening, which focused on “thoughts of killing yourself” within the past week, within the past month, and during one’s entire lifespan.¹

Of these patients, 65.4% who screened positive for SI also screened positive for depression on the PHQ-9. The PHQ-9 also accurately identified more patients who had attempted suicide in the past 3 months than lifetime SI—however, lifetime SI accurately identified more patients who had attempted suicide within the past 6 and 12 months. “Our findings indicated depression screening with the PHQ-9 outperformed suicide risk screening under most conditions,” the investigators wrote, ultimately concluding that depression screening alone was not sufficient to identify all patients at risk for suicide.¹

“Our results also suggest that supplementing the PHQ-9 with additional SI screening items did not meaningfully improve the identification of primary care patients who attempted suicide, particularly in the near term,” the investigators wrote. “On the contrary, our results suggest the possibility that additional SI screening—particularly screening that focuses on current or recent SI—may have the unintended effect of negatively influencing clinical decision-making.”

The study has important implications for suicide prevention efforts. Suicide is a leading cause of death in the United States. According to the Centers for Disease Control and Prevention (CDC), suicide rates have been increasing in recent years, with adults aged 35 to 64 years accounting for nearly half of all suicides in the United States; with adults aged 75 years and older committing suicide at a rate of 20.3 per 100,000 suicides; and with suicide rates for children and young adults aged 10 to 24 years increasing by more than 50% between 2000 and 2021.²

“Our results indicate that depression screening was superior to suicide risk screening under most conditions for the specific purpose of identifying patients who would subsequently attempt suicide, with the PHQ-9 performing the best and screening for ‘thoughts of killing yourself’ within the past week or past month performing the worst,” the investigators concluded. “Use of the PHQ-9 instead of the PHQ-2 could markedly improve the identification of at-risk patients in primary care, particularly those who are most likely to attempt suicide in the short term.”

See more news, research, and expert commentaries about depression, suicide prevention, and the importance of screening at psychiatrictimes.com.

References

1. Bryan CJ, Allen MH, Bryan AO, et al. Does suicide risk screening improve the identification of primary care patients who will attempt suicide versus depression screening alone? Jt Comm J Qual Patient Saf. 2023;000:1-9.

2. Disparities in suicide. Centers for Disease Control and Prevention. Reviewed May 9, 2023. Accessed October 5, 2023. https://www.cdc.gov/suicide/facts/disparities-in-suicide.html

Note: ChatPDF was used in the preparation of this article.