Patient Health Questionnaire and Suicide Ideation
SOURCE: Simon GE, et al. Risk of suicide attempt and suicide death following completion of the Patient Health Questionnaire depression module in community practice. J Clin Psychiatry 2016;77:221-227.
The most recent guidance from the U.S. Preventive Services Task Force endorses screening for depression in all adults. The Patient Health Questionnaire (PHQ) is a commonly used tool for depression screening. An attractive benefit about this screening tool is that no permission is required for copying and using the screener in clinical practice.
Simon et al reviewed results of PHQ screenings of more than 500,000 adults obtained during the 2007-2012 interval. Patients had visited primary care clinicians as well as mental health specialists. Among this population, there were 9203 nonfatal suicide attempts and 484 suicide deaths recorded during the same interval.
Patients who reported “thoughts of death or self-harm” on the PHQ as “not at all” were seven-fold less likely to attempt suicide in the 2 years following their screening than those who responded with “nearly every day” (0.5% vs 3.5% rate of suicide attempt). A similar relative risk of suicide death — five-fold increase in the latter group — was found.
Over time, incidence of suicide declined but remained elevated as much as two- to five-fold for at least 18 months post-positive screening. Hence, clinicians should take positive results on the PHQ seriously and institute appropriate suicide prevention methods. Unfortunately, no depression or suicide screener is perfect. More than one-third of all suicide attempts and deaths occurred within 30 days of responses by screenees who had answered “not at all” to the PHQ question, “In the past 2 weeks, have you had thoughts that you would be better off dead or of hurting yourself in some way?”
Clinicians should take positive results on the Patient Health Questionnaire seriously and institute appropriate suicide prevention methods.
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